| Spa Dental, Pc | |
|
68 Milton Avenue Ballston Spa NY 12020 | |
| (518) 885-1791 | |
| (518) 885-1147 |
| Full Name | Spa Dental, Pc |
|---|---|
| Speciality | Dentist |
| Location | 68 Milton Avenue, Ballston Spa, New York |
| Authorized Official Name and Position | James T Hansen (OWNER/PRESIDENT) |
| Authorized Official Contact | 5188851791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spa Dental, Pc 68 Milton Avenue Ballston Spa NY 12020 Ph: (518) 885-1791 | Spa Dental, Pc 68 Milton Avenue Ballston Spa NY 12020 Ph: (518) 885-1791 |
| NPI Number | 1700135886 |
|---|---|
| Provider Enumeration Date | 09/05/2012 |
| Last Update Date | 09/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700135886 | NPI | - | NPPES |
| 03275514 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 046659 (New York) | Primary |
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