Individual
JUSTIN BIRDSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
501 PLAZA DR, VESTAL, NY 13850-3769
(607) 797-5932
Mailing address
501 PLAZA DR, VESTAL, NY 13850-3769
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057956
NY
Other
Enumeration date
06/09/2014
Last updated
07/27/2015
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