| Northeast Family Dental Pllc | |
|
2329 N Triphammer Rd Ithaca NY 14850-1011 | |
| (607) 257-0060 | |
| (607) 257-0042 |
| Full Name | Northeast Family Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2329 N Triphammer Rd, Ithaca, New York |
| Authorized Official Name and Position | Marina R Manunts (OWNER) |
| Authorized Official Contact | 6072570060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Family Dental Pllc 2329 N Triphammer Rd Ithaca NY 14850-1011 Ph: (607) 257-0060 | Northeast Family Dental Pllc 2329 N Triphammer Rd Ithaca NY 14850-1011 Ph: (607) 257-0060 |
| NPI Number | 1366583288 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 05/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366583288 | NPI | - | NPPES |
| 02299296 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 050046-1 (New York) | Primary |
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