Organization
BREWERTON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMADEH R NOSEGBE DMD (OWNER)
(315) 676-2209
Entity
Organization
Contact information
Practice address
5501 BARTEL RD, BREWERTON, NY 13029-8701
(315) 676-2209
(315) 676-2247
Mailing address
PO BOX 830, BREWERTON, NY 13029-0830
(315) 676-2209
(315) 676-2247
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051614
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02570547
—
NY
Enumeration date
03/09/2007
Last updated
08/22/2020
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