Provider Demographics
NPI:1891020475
Name:ACCESS FAMILY DENTAL AND DENTURES
Entity type:Organization
Organization Name:ACCESS FAMILY DENTAL AND DENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-695-2128
Mailing Address - Street 1:219 COUNTY RTE 57
Mailing Address - Street 2:THREE RIVERS PLAZA
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135
Mailing Address - Country:US
Mailing Address - Phone:315-695-2128
Mailing Address - Fax:
Practice Address - Street 1:219 COUNTY ROUTE 57
Practice Address - Street 2:THREE RIVERS PLAZA
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-3300
Practice Address - Country:US
Practice Address - Phone:315-695-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027837122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty