Provider Demographics
NPI:1861567554
Name:ADIRONDACK FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:ADIRONDACK FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:STALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-896-7293
Mailing Address - Street 1:7990 STATE RTE 12
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304
Mailing Address - Country:US
Mailing Address - Phone:315-896-7293
Mailing Address - Fax:315-896-7294
Practice Address - Street 1:7990 STATE RTE 12
Practice Address - Street 2:SUITE 1
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304
Practice Address - Country:US
Practice Address - Phone:315-896-7293
Practice Address - Fax:315-896-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04748711223G0001X
NY04748611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty