Provider Demographics
NPI:1265274211
Name:BARDONIA DENTAL PLLC
Entity type:Organization
Organization Name:BARDONIA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-886-8275
Mailing Address - Street 1:446 ROUTE 304 STE D
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:446 ROUTE 304 STE D
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1646
Practice Address - Country:US
Practice Address - Phone:845-623-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty