| Oakdale Mall Dental Llp | |
|
601-635 Harry L Dr 46 Johnson City NY 13790-1246 | |
| (607) 770-8888 | |
| (607) 770-8881 |
| Full Name | Oakdale Mall Dental Llp |
|---|---|
| Speciality | Dentist |
| Location | 601-635 Harry L Dr, Johnson City, New York |
| Authorized Official Name and Position | Ross Krasnov (OWNER) |
| Authorized Official Contact | 6077708888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oakdale Mall Dental Llp 601-635 Harry L Dr 46 Johnson City NY 13790-1246 Ph: (607) 770-8888 | Oakdale Mall Dental Llp 601-635 Harry L Dr 46 Johnson City NY 13790-1246 Ph: (607) 770-8888 |
| NPI Number | 1801156674 |
|---|---|
| Provider Enumeration Date | 05/25/2012 |
| Last Update Date | 05/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801156674 | NPI | - | NPPES |
| 01580001 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 046043 (New York) | Primary |
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