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Organization
SOUTHWOODS BOULEVARD DENTAL, P.C.
Active
Organization
SOUTHWOODS BOULEVARD DENTAL, P.C.
Active
Parent organization
SOUTHWOODS BOULEVARD DENTAL, P.C.
Other names
Capital District Oral & Maxillofacial Surgeons
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHWOODS BOULEVARD DENTAL, P.C.
Authorized official
LEAH ANN MAYLOTT (CREDENTIALING ADMINISTRATOR)
(860) 874-8198
Entity
Organization
Contact information
Practice address
7 SOUTHWOODS BLVD STE 1, ALBANY, NY 12211-2526
(518) 445-2505
Mailing address
330 WHITNEY AVE STE 740, HOLYOKE, MA 01040-2789
(413) 382-7022
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
01/10/2022
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