Provider Demographics
NPI:1851025324
Name:PALMA AND NARDOZZA DENTAL SERVICES
Entity Type:Organization
Organization Name:PALMA AND NARDOZZA DENTAL SERVICES
Other - Org Name:BALDWINSVILLE GENTLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-798-3974
Mailing Address - Street 1:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-4008
Mailing Address - Country:US
Mailing Address - Phone:315-635-3671
Mailing Address - Fax:
Practice Address - Street 1:30 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1126
Practice Address - Country:US
Practice Address - Phone:315-635-3671
Practice Address - Fax:315-635-6482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMA AND NARDOZZA DENTAL SERVICES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-12
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042879OtherNEW YORK STATE BOARD OF DENTISTRY