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Organization
PINE STREET DENTAL ASSOCIATES, P.C.
Active
Organization
PINE STREET DENTAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MATTHEW FLIEGLER D.D.S. (DENTIST, OWNER)
(845) 338-6900
Entity
Organization
Contact information
Practice address
138 PINE ST, SUITE 210, KINGSTON, NY 12401-4947
(845) 338-6900
(845) 338-6013
Mailing address
138 PINE ST, SUITE 210, KINGSTON, NY 12401-4947
(845) 338-6900
(845) 338-6013
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0526781
NY
1223G0001X
General Practice Dentistry
Primary
029231
NY
1223G0001X
General Practice Dentistry
032380
NY
1223G0001X
General Practice Dentistry
038724
NY
1223G0001X
General Practice Dentistry
040046
NY
1223G0001X
General Practice Dentistry
0487491
NY
1223P0300X
Periodontics
044009
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029231
NYS DENTAL LICENSE
NY
01
—
032380
NYS DENTAL LICENSE
NY
01
—
038724
NYS DENTAL LICENSE
NY
01
—
040046
NYS DENTAL LICENSE
NY
01
—
044009
NYS DENTAL LICENSE
NY
01
—
0487491
NYS DENTAL LICENSE
NY
01
—
0526781
NYS DENTAL LICENSE
NY
Enumeration date
02/24/2006
Last updated
09/10/2008
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