Provider Demographics
NPI:1861748055
Name:ELMWOOD DENTAL GROUP - FAMILY, PC
Entity type:Organization
Organization Name:ELMWOOD DENTAL GROUP - FAMILY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:NASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-461-5350
Mailing Address - Street 1:1950 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5620
Mailing Address - Country:US
Mailing Address - Phone:585-461-4350
Mailing Address - Fax:585-461-9365
Practice Address - Street 1:1950 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5620
Practice Address - Country:US
Practice Address - Phone:585-461-4350
Practice Address - Fax:585-461-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty