Provider Demographics
NPI:1942001078
Name:HARBORSIDE DENTAL TEAM AT CANANDAIGUA
Entity type:Organization
Organization Name:HARBORSIDE DENTAL TEAM AT CANANDAIGUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTETOMASO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-394-3736
Mailing Address - Street 1:3170 WEST ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1786
Mailing Address - Country:US
Mailing Address - Phone:585-208-9285
Mailing Address - Fax:585-208-9285
Practice Address - Street 1:3170 WEST ST STE 250
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1786
Practice Address - Country:US
Practice Address - Phone:585-394-3737
Practice Address - Fax:585-394-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental