Provider Demographics
NPI:1457880742
Name:WOODSTOCK GENERAL & IMPLANT DENTISTRY
Entity type:Organization
Organization Name:WOODSTOCK GENERAL & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-679-3706
Mailing Address - Street 1:121 ROUTE 375 STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1815
Mailing Address - Country:US
Mailing Address - Phone:845-679-3706
Mailing Address - Fax:
Practice Address - Street 1:121 ROUTE 375
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498
Practice Address - Country:US
Practice Address - Phone:845-679-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies