| Adirondack Periodontics Pllc | |
|
4161 Route 22 Plattsburgh NY 12901-5883 | |
| (518) 563-0040 | |
| (518) 562-0632 |
| Full Name | Adirondack Periodontics Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4161 Route 22, Plattsburgh, New York |
| Authorized Official Name and Position | Gordon H Davis (OWNER) |
| Authorized Official Contact | 5185630040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adirondack Periodontics Pllc 4161 Route 22 Plattsburgh NY 12901-5883 Ph: (518) 563-0040 | Adirondack Periodontics Pllc 4161 Route 22 Plattsburgh NY 12901-5883 Ph: (518) 563-0040 |
| NPI Number | 1689816274 |
|---|---|
| Provider Enumeration Date | 03/30/2009 |
| Last Update Date | 04/29/2024 |
| Medicare PECOS PAC ID | 0042368946 |
|---|---|
| Medicare Enrollment ID | O20090504000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689816274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | 047679-1 (New York) | Primary |
| Provider Name | Gordon H Davis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1528096765 PECOS PAC ID: 7416005301 Enrollment ID: I20090504000157 |
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