Provider Demographics
NPI:1205896735
Name:CARY, PHILLIP GEOFFREY (DDS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:GEOFFREY
Last Name:CARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9372
Mailing Address - Country:US
Mailing Address - Phone:585-727-3218
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1022
Practice Address - Country:US
Practice Address - Phone:585-394-3322
Practice Address - Fax:585-394-1175
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010039992OtherBLUE CHOICE OF ROCHESTER
NY00959182Medicaid
NY7892OtherBLUE SHIELD OF ROCHESTER
NY1205896735Medicare NSC