Provider Demographics
NPI:1780218081
Name:NY METRO DENTAL, PC
Entity Type:Organization
Organization Name:NY METRO DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG. MGR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-382-7022
Mailing Address - Street 1:330 WHITNEY AVE STE 740
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119-01 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:413-382-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NY METRO DENTAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty