Provider Demographics
NPI:1780715201
Name:NMC GENERAL DENTISTRY, PC
Entity type:Organization
Organization Name:NMC GENERAL DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEROLA
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-452-2700
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 3K
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2700
Mailing Address - Fax:315-452-2705
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 3K
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2700
Practice Address - Fax:315-452-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042450-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty