Provider Demographics
NPI:1831897396
Name:WATKINS GLEN FAMILY DENTISTRY P.L.L.C.
Entity type:Organization
Organization Name:WATKINS GLEN FAMILY DENTISTRY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAENTGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-535-4666
Mailing Address - Street 1:703 S DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1614
Mailing Address - Country:US
Mailing Address - Phone:607-535-4666
Mailing Address - Fax:607-535-4287
Practice Address - Street 1:703 S DECATUR ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1614
Practice Address - Country:US
Practice Address - Phone:607-535-4666
Practice Address - Fax:607-535-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty