Provider Demographics
NPI:1730649039
Name:DIANE K. RADEMACHER, DDS,PLLC
Entity Type:Organization
Organization Name:DIANE K. RADEMACHER, DDS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADMECHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-885-3877
Mailing Address - Street 1:7 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1238
Mailing Address - Country:US
Mailing Address - Phone:518-885-3877
Mailing Address - Fax:518-885-3229
Practice Address - Street 1:7 UNION ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1238
Practice Address - Country:US
Practice Address - Phone:518-885-3877
Practice Address - Fax:518-885-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty