Provider Demographics
NPI:1710020672
Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Entity Type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Other - Org Name:1ST ADVANTAGE DENTAL - CLIFTON PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1532 ROUTE 9 STE 5
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5605
Mailing Address - Country:US
Mailing Address - Phone:518-371-8481
Mailing Address - Fax:518-371-6326
Practice Address - Street 1:1532 ROUTE 9 STE 5
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-5605
Practice Address - Country:US
Practice Address - Phone:518-371-8481
Practice Address - Fax:518-371-6326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty