Provider Demographics
NPI:1023151982
Name:CAPITAL AREA HUDSON VALLEY NY DENTAL
Entity type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-587-3831
Mailing Address - Street 1:6 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5601
Mailing Address - Country:US
Mailing Address - Phone:518-348-0240
Mailing Address - Fax:518-348-0248
Practice Address - Street 1:80 FLAT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3272
Practice Address - Country:US
Practice Address - Phone:802-254-6634
Practice Address - Fax:802-254-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty