Mary Bice, DENTALASSISTANT EFDA

Individual provider Active NPI Dental Assistant · Fort Drum, NY

NPI 1033568720 · NPPES record last updated Jun 3, 2016

Key facts

NPI
1033568720
Entity type
Individual (NPI type 1)
Primary specialty
Dental Assistant 126800000X
Practice address
10590 Enduring Freedom Dr
Fort Drum, NY 13602-5005
Phone
(315) 772-6234
NPI assigned
Jun 3, 2016
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X Yes

Addresses

Primary practice location

10590 Enduring Freedom Dr
Fort Drum, NY 13602-5005

Mailing address

10590 Enduring Freedom Dr
Fort Drum, NY 13602-5005
Phone (315) 772-6234

Other providers in Fort Drum, NY

All providers in Fort Drum, NY · Dental Assistant in New York

Sources for this page

Verify at the official NPI Registry.