Brewerton Family Dentistry
Organization Active NPI Dentist · Brewerton, NY
NPI 1164553079 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1164553079
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 051614 (NY)
- Legal business name
- BREWERTON FAMILY DENTISTRY
- Practice address
- 5501 Bartel Rd
Brewerton, NY 13029-8701 - Phone
- (315) 676-2209
- Fax
- (315) 676-2247
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Imadeh R Nosegbe, DMD
- Title
- Owner
- Phone
- (315) 676-2209
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 051614 | NY | Yes |
Addresses
Primary practice location
5501 Bartel Rd
Brewerton, NY 13029-8701
Mailing address
PO Box 830
Brewerton, NY 13029-0830
Phone (315) 676-2209
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02570547 | Medicaid | NY |
Other providers in Brewerton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.