Provider Demographics
NPI:1013188788
Name:CHEMUNG DENTAL HEALTH P.C.
Entity Type:Organization
Organization Name:CHEMUNG DENTAL HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-795-5000
Mailing Address - Street 1:170 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1844
Mailing Address - Country:US
Mailing Address - Phone:607-795-5000
Mailing Address - Fax:607-739-3166
Practice Address - Street 1:170 MILLER ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1844
Practice Address - Country:US
Practice Address - Phone:607-795-5000
Practice Address - Fax:607-739-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328951305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02278540Medicaid
NY00306712Medicaid