Organization Name: | CANANDAIGUA DENTAL HEALTH, PLLC |
NPI Number: | 1114064938 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JO ANNA S GAGLIARDI (ADMINISTRATOR) |
Mailing Address: | 317 S Main St Canandaigua |
State: | NY US |
Postal Code: | 144242118 |
Phone Number: | 5853945910 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 045901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |