| Dynamic Dental Services | |
|
2121 6th Ave Troy NY 12180-2849 | |
| (518) 274-6741 | |
| (518) 274-6748 |
| Full Name | Dynamic Dental Services |
|---|---|
| Speciality | Dentist |
| Location | 2121 6th Ave, Troy, New York |
| Authorized Official Name and Position | Brenda Yvonne Porter (PRESIDENT) |
| Authorized Official Contact | 5182746741 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Dental Services 2121 6th Ave Troy NY 12180-2849 Ph: (518) 274-6741 | Dynamic Dental Services 2121 6th Ave Troy NY 12180-2849 Ph: (518) 274-6741 |
| NPI Number | 1104112267 |
|---|---|
| Provider Enumeration Date | 06/27/2011 |
| Last Update Date | 06/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104112267 | NPI | - | NPPES |
| 01568836 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 04449-1 (New York) | Primary |
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