| Countryside Dental | |
|
42 Kinderhook St Chatham NY 12037-1207 | |
| (518) 392-5231 | |
| (518) 392-7339 |
| Full Name | Countryside Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 42 Kinderhook St, Chatham, New York |
| Authorized Official Name and Position | Domenic Riccobono (OWNER) |
| Authorized Official Contact | 5183925231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Countryside Dental 42 Kinderhook St Chatham NY 12037-1207 Ph: (518) 392-5231 | Countryside Dental 42 Kinderhook St Chatham NY 12037-1207 Ph: (518) 392-5231 |
| NPI Number | 1952558074 |
|---|---|
| Provider Enumeration Date | 08/20/2008 |
| Last Update Date | 08/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952558074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 045941 (New York) | Primary |
| 1223G0001X | Dentist - General Practice | 039271 (New York) | Secondary |