Provider Demographics
NPI:1811160567
Name:AHLGRIM AND WARD DENTAL ASSOCIATES
Entity type:Organization
Organization Name:AHLGRIM AND WARD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:AHLGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-782-2241
Mailing Address - Street 1:125 MULLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3615
Mailing Address - Country:US
Mailing Address - Phone:315-782-2241
Mailing Address - Fax:315-785-5521
Practice Address - Street 1:125 MULLIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3615
Practice Address - Country:US
Practice Address - Phone:315-782-2241
Practice Address - Fax:315-785-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39123261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental