| New York Dental Llc | |
|
4501 Vestal Pkwy E Vestal NY 13850-3565 | |
| (607) 777-1340 | |
| (607) 777-1345 |
| Full Name | New York Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 4501 Vestal Pkwy E, Vestal, New York |
| Authorized Official Name and Position | Sukhminder Singh Pannu (OWNER) |
| Authorized Official Contact | 6077771340 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New York Dental Llc 4501 Vestal Pkwy E Vestal NY 13850-3565 Ph: (607) 777-1340 | New York Dental Llc 4501 Vestal Pkwy E Vestal NY 13850-3565 Ph: (607) 777-1340 |
| NPI Number | 1164403093 |
|---|---|
| Provider Enumeration Date | 11/08/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164403093 | NPI | - | NPPES |
| 02121915 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 048923 (New York) | Primary |
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