Provider Demographics
NPI:1952488413
Name:ONEIDA DENTAL PRACTICE PC
Entity Type:Organization
Organization Name:ONEIDA DENTAL PRACTICE PC
Other - Org Name:ONEIDA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RUSSELL-BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-363-4850
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2125
Mailing Address - Country:US
Mailing Address - Phone:315-363-4850
Mailing Address - Fax:315-363-4678
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2125
Practice Address - Country:US
Practice Address - Phone:315-363-4850
Practice Address - Fax:315-363-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038236-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty