Provider Demographics
NPI:1922049964
Name:TEUCHTLER, JR,, ROBERT G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:TEUCHTLER, JR,
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4508
Mailing Address - Country:US
Mailing Address - Phone:607-723-0187
Mailing Address - Fax:607-772-6692
Practice Address - Street 1:37 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4508
Practice Address - Country:US
Practice Address - Phone:607-723-0187
Practice Address - Fax:607-772-6692
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0266651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603067Medicaid