Provider Demographics
NPI:1790971869
Name:WALTON DENTAL PLLC
Entity Type:Organization
Organization Name:WALTON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LYUBARSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-865-4000
Mailing Address - Street 1:132 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1331
Mailing Address - Country:US
Mailing Address - Phone:607-865-4000
Mailing Address - Fax:
Practice Address - Street 1:132 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1331
Practice Address - Country:US
Practice Address - Phone:607-865-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY493851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty