Provider Demographics
NPI:1730752908
Name:ROBERT J AGNETTA DDS MS PLLC
Entity type:Organization
Organization Name:ROBERT J AGNETTA DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-863-6861
Mailing Address - Street 1:15 PIERREPONT AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2026
Mailing Address - Country:US
Mailing Address - Phone:315-267-6588
Mailing Address - Fax:
Practice Address - Street 1:81 BRINKERHOFF ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2729
Practice Address - Country:US
Practice Address - Phone:518-561-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty