Provider Demographics
NPI:1295312528
Name:CAZENOVIA CREEKSIDE DENTAL, PLLC
Entity type:Organization
Organization Name:CAZENOVIA CREEKSIDE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-754-2217
Mailing Address - Street 1:2521 VESTAL PKWY W
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1056
Mailing Address - Country:US
Mailing Address - Phone:607-754-2217
Mailing Address - Fax:
Practice Address - Street 1:4 CHENANGO ST
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1400
Practice Address - Country:US
Practice Address - Phone:315-655-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LALOR DENTISTRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty