| NPI | 1821486754 |
|---|---|
| Doing Business As | THE SMILE LODGE |
| Entity Type | Organization |
| Authorized Contact | JAMES P MCDONNELL Member 518-373-1181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 48803) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053734) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 054764) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 054477) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056708) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057555) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057644) | |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2015-01-02 |