Organization
FALL CREEK FAMILY DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY KINNEY (OFFICE MANAGER)
(607) 272-8118
Entity
Organization
Contact information
Practice address
501 N CAYUGA ST, ITHACA, NY 14850-3670
(607) 272-8118
Mailing address
501 N CAYUGA ST, ITHACA, NY 14850-3670
(607) 272-8118
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
044135
NY
261QD0000X
Dental Clinic/Center
044297
NY
Other
Enumeration date
05/11/2012
Last updated
05/11/2012
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