Provider Demographics
NPI:1689064123
Name:TRUMANSBURG FAMILY DENTISTRY
Entity Type:Organization
Organization Name:TRUMANSBURG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-771-9532
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:50 E. MAIN ST
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-0446
Mailing Address - Country:US
Mailing Address - Phone:607-387-7821
Mailing Address - Fax:607-387-9893
Practice Address - Street 1:50 E. MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886
Practice Address - Country:US
Practice Address - Phone:607-387-7821
Practice Address - Fax:607-387-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty