Provider Demographics
NPI:1811385826
Name:APPLE BLOSSOM DENTAL,PLLC
Entity Type:Organization
Organization Name:APPLE BLOSSOM DENTAL,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:FETHIYE
Authorized Official - Middle Name:SEVDE
Authorized Official - Last Name:ERSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-589-4471
Mailing Address - Street 1:3800 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9340
Mailing Address - Country:US
Mailing Address - Phone:315-589-4471
Mailing Address - Fax:315-589-9427
Practice Address - Street 1:3800 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9340
Practice Address - Country:US
Practice Address - Phone:315-589-4471
Practice Address - Fax:315-589-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0537181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03325546Medicaid