Provider Demographics
NPI:1790857944
Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL, PC
Entity type:Organization
Organization Name:CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
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 6C
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 1:1201 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1028
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:518-785-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty