| Gouverneur Dental Associates, P.c. | |
|
354 E Main St Gouverneur NY 13642-1512 | |
| (315) 287-4000 | |
| (315) 287-4109 |
| Full Name | Gouverneur Dental Associates, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 354 E Main St, Gouverneur, New York |
| Authorized Official Name and Position | Scott R. Day (PRESIDENT) |
| Authorized Official Contact | 3152874000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gouverneur Dental Associates, P.c. 354 E Main St Po Box 427 Gouverneur NY 13642-1512 Ph: (315) 287-4000 | Gouverneur Dental Associates, P.c. 354 E Main St Gouverneur NY 13642-1512 Ph: (315) 287-4000 |
| NPI Number | 1407846306 |
|---|---|
| Provider Enumeration Date | 10/24/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407846306 | NPI | - | NPPES |
| 01134569 | Medicaid | NY | |
| 02572989 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 040862 (New York) | Primary |
Nicholas Frandy Gardner Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 E Main St, Gouverneur, NY 13642 Phone: -- |