Provider Demographics
NPI:1679652747
Name:ASSOCIATED DENTAL ARTS, PC
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL ARTS, PC
Other - Org Name:ROSE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ONOFRIO
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-690-4102
Mailing Address - Street 1:5 PINE WEST PLZ
Mailing Address - Street 2:WASHINGTON AVENUE EXTENSION
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5587
Mailing Address - Country:US
Mailing Address - Phone:518-456-7673
Mailing Address - Fax:518-456-8256
Practice Address - Street 1:5 PINE WEST PLZ
Practice Address - Street 2:WASHINGTON AVENUE EXTENSION
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5587
Practice Address - Country:US
Practice Address - Phone:518-456-7673
Practice Address - Fax:518-456-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0262791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197400Medicaid