Provider Demographics
NPI:1689904302
Name:DENTAL CARE WITH A DIFFERENCE, PC
Entity Type:Organization
Organization Name:DENTAL CARE WITH A DIFFERENCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COMISI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-272-3433
Mailing Address - Street 1:2333 N TRIPHAMMER RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1082
Mailing Address - Country:US
Mailing Address - Phone:607-272-3433
Mailing Address - Fax:607-277-4731
Practice Address - Street 1:2333 N TRIPHAMMER RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1082
Practice Address - Country:US
Practice Address - Phone:607-272-3433
Practice Address - Fax:607-277-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0377981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty