Provider Demographics
NPI:1063871564
Name:THE KID'S DENTIST, PC
Entity type:Organization
Organization Name:THE KID'S DENTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROZHON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-451-6260
Mailing Address - Street 1:7282 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3719
Mailing Address - Country:US
Mailing Address - Phone:315-451-6260
Mailing Address - Fax:315-451-1022
Practice Address - Street 1:7282 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3719
Practice Address - Country:US
Practice Address - Phone:315-451-6260
Practice Address - Fax:315-451-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03627938Medicaid