Provider Demographics
NPI:1821390147
Name:PARKWOOD DENTAL CARE, P.C.
Entity type:Organization
Organization Name:PARKWOOD DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-225-1010
Mailing Address - Street 1:3120 W RIDGE RD
Mailing Address - Street 2:STORE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3213
Mailing Address - Country:US
Mailing Address - Phone:585-225-1010
Mailing Address - Fax:
Practice Address - Street 1:3120 W RIDGE RD
Practice Address - Street 2:STORE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3213
Practice Address - Country:US
Practice Address - Phone:585-225-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042165-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty