| Legacy Dental Practice Pllc | |
|
190 Ferguson Dr Hilton NY 14468-9504 | |
| (585) 720-1370 | |
| Not Available |
| Full Name | Legacy Dental Practice Pllc |
|---|---|
| Speciality | Dentist |
| Location | 190 Ferguson Dr, Hilton, New York |
| Authorized Official Name and Position | Gary Louis Gusmerotti (PRESIDENT) |
| Authorized Official Contact | 5857201370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Dental Practice Pllc 31 Erie Canal Dr Suite H Rochester NY 14626-4602 Ph: (585) 720-1370 | Legacy Dental Practice Pllc 190 Ferguson Dr Hilton NY 14468-9504 Ph: (585) 720-1370 |
| NPI Number | 1063678613 |
|---|---|
| Provider Enumeration Date | 08/04/2008 |
| Last Update Date | 08/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063678613 | NPI | - | NPPES |
| 1477611432 | Other | NY | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 053408 (New York) | Primary |
Modern Family Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3 West Ave, Hilton, NY 14468 Phone: 585-392-2555 |