| Family Dentistry Pc | |
|
89 North St Granville NY 12832-1138 | |
| (518) 642-2111 | |
| (518) 642-2891 |
| Full Name | Family Dentistry Pc |
|---|---|
| Speciality | Dentist |
| Location | 89 North St, Granville, New York |
| Authorized Official Name and Position | Jennifer R Kelley (DENTIST) |
| Authorized Official Contact | 5186422111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dentistry Pc 89 North St Granville NY 12832-1138 Ph: (518) 642-2111 | Family Dentistry Pc 89 North St Granville NY 12832-1138 Ph: (518) 642-2111 |
| NPI Number | 1215920632 |
|---|---|
| Provider Enumeration Date | 08/31/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215920632 | NPI | - | NPPES |
| 1010081 | Medicaid | VT | |
| 02375744 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |