| W & R Geyser Rd, Llc | |
|
424 Geyser Rd Ballston Spa NY 12020-3021 | |
| (518) 885-1095 | |
| (518) 885-1137 |
| Full Name | W & R Geyser Rd, Llc |
|---|---|
| Speciality | Dentist |
| Location | 424 Geyser Rd, Ballston Spa, New York |
| Authorized Official Name and Position | Nicholas J. Chauvin (OWNER) |
| Authorized Official Contact | 5188851095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| W & R Geyser Rd, Llc 424 Geyser Rd Ballston Spa NY 12020-3021 Ph: (518) 885-1095 | W & R Geyser Rd, Llc 424 Geyser Rd Ballston Spa NY 12020-3021 Ph: (518) 885-1095 |
| NPI Number | 1376874461 |
|---|---|
| Provider Enumeration Date | 01/29/2010 |
| Last Update Date | 02/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376874461 | NPI | - | NPPES |
| 00527913 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 32884 (New York) | Primary |
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