Provider Demographics
NPI:1962558742
Name:ARCADE-SPRINGVILLE DENTAL ARTS GROUP LLP
Entity type:Organization
Organization Name:ARCADE-SPRINGVILLE DENTAL ARTS GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-492-1567
Mailing Address - Street 1:154 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1204
Mailing Address - Country:US
Mailing Address - Phone:585-492-1567
Mailing Address - Fax:
Practice Address - Street 1:154 NORTH ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1204
Practice Address - Country:US
Practice Address - Phone:585-492-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty