Provider Demographics
NPI:1144366857
Name:TARDUGNO DENTAL OFFICE PC
Entity type:Organization
Organization Name:TARDUGNO DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:TARDUGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-337-5880
Mailing Address - Street 1:702 N WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-337-5880
Mailing Address - Fax:315-339-6729
Practice Address - Street 1:702 N WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-337-5880
Practice Address - Fax:315-339-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty