Provider Demographics
NPI:1821267121
Name:PHYLLIS A NORTON DDS & NATALIA M. BAUSBACK DMD P.C.
Entity Type:Organization
Organization Name:PHYLLIS A NORTON DDS & NATALIA M. BAUSBACK DMD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-286-5354
Mailing Address - Street 1:324 N GREENBUSH RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8518
Mailing Address - Country:US
Mailing Address - Phone:518-286-5354
Mailing Address - Fax:
Practice Address - Street 1:324 N GREENBUSH ROAD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8518
Practice Address - Country:US
Practice Address - Phone:518-286-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0400515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty