| Hudson Valley Mall Dental Llp | |
|
1300 Ulster Ave 160 Kingston NY 12401-1501 | |
| (845) 336-0400 | |
| Not Available |
| Full Name | Hudson Valley Mall Dental Llp |
|---|---|
| Speciality | Dentist |
| Location | 1300 Ulster Ave, Kingston, New York |
| Authorized Official Name and Position | Ross Krasnov (OWNER) |
| Authorized Official Contact | 8453360400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hudson Valley Mall Dental Llp 1300 Ulster Ave 160 Kingston NY 12401 Ph: (845) 336-0400 | Hudson Valley Mall Dental Llp 1300 Ulster Ave 160 Kingston NY 12401-1501 Ph: (845) 336-0400 |
| NPI Number | 1447550033 |
|---|---|
| Provider Enumeration Date | 10/28/2010 |
| Last Update Date | 10/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447550033 | NPI | - | NPPES |
| 01580001 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 046043 (New York) | Primary |
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