Provider Demographics
NPI:1548498587
Name:ALBANY ACCESS DENTISTRY, PLLC
Entity type:Organization
Organization Name:ALBANY ACCESS DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LICENSING & CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-750-0342
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4748
Mailing Address - Country:US
Mailing Address - Phone:518-464-0402
Mailing Address - Fax:518-464-0409
Practice Address - Street 1:618 CHURCH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-2428
Practice Address - Country:US
Practice Address - Phone:615-750-0342
Practice Address - Fax:615-750-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03195631Medicaid