Organization
COUNTRYSIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMENIC RICCOBONO DDS (OWNER)
(518) 392-5231
Entity
Organization
Contact information
Practice address
42 KINDERHOOK ST, CHATHAM, NY 12037-1207
(518) 392-5231
(518) 392-7339
Mailing address
42 KINDERHOOK ST, CHATHAM, NY 12037-1207
(518) 392-5231
(518) 392-7339
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
039271
NY
1223G0001X
General Practice Dentistry
Primary
045941
NY
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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