Provider Demographics
NPI:1871249623
Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Entity Type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Other - Org Name:1ST ADVANTAGE DENTAL - NISKAYUNA US 9
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:445 BALLTOWN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-2269
Mailing Address - Country:US
Mailing Address - Phone:518-344-4942
Mailing Address - Fax:
Practice Address - Street 1:445 BALLTOWN RD STE 2
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2269
Practice Address - Country:US
Practice Address - Phone:518-344-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty