Provider Demographics
NPI:1699075267
Name:DYNAMIC DENTAL SYSTEMS INC
Entity type:Organization
Organization Name:DYNAMIC DENTAL SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:SPADARO
Authorized Official - Last Name:SPADARO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:518-688-0438
Mailing Address - Street 1:2210 GUILDERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-4405
Mailing Address - Country:US
Mailing Address - Phone:518-866-0438
Mailing Address - Fax:518-344-5375
Practice Address - Street 1:2210 GUILDERLAND AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-4405
Practice Address - Country:US
Practice Address - Phone:518-866-0438
Practice Address - Fax:518-344-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041791122300000X
126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No126900000XDental ProvidersDental Laboratory TechnicianGroup - Multi-Specialty