Provider Demographics
NPI:1366566523
Name:FINGER LAKES ORTHODONTICS PC
Entity type:Organization
Organization Name:FINGER LAKES ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-739-2551
Mailing Address - Street 1:10921 CATON CREST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830
Mailing Address - Country:US
Mailing Address - Phone:607-765-1233
Mailing Address - Fax:
Practice Address - Street 1:2840 WESTINGHOUSE RD
Practice Address - Street 2:FINGER LAKES ORTHODONTICS PC
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845
Practice Address - Country:US
Practice Address - Phone:607-739-2551
Practice Address - Fax:607-739-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04408111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty