Provider Demographics
NPI:1710113444
Name:THE SALVATION ARMY
Entity Type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:SAVING SMILES DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOUTHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-620-7329
Mailing Address - Street 1:440 WEST NYACK ROAD
Mailing Address - Street 2:PO BOX C-635
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1739
Mailing Address - Country:US
Mailing Address - Phone:845-620-7200
Mailing Address - Fax:845-620-7615
Practice Address - Street 1:217 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-1443
Practice Address - Country:US
Practice Address - Phone:814-677-4056
Practice Address - Fax:814-676-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty