Provider Demographics
NPI:1043334352
Name:NEW COUNTRY DENTAL GROUP
Entity type:Organization
Organization Name:NEW COUNTRY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-455-7079
Mailing Address - Street 1:2806 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3248
Mailing Address - Country:US
Mailing Address - Phone:315-455-7079
Mailing Address - Fax:315-454-9187
Practice Address - Street 1:2806 COURT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3248
Practice Address - Country:US
Practice Address - Phone:315-455-7079
Practice Address - Fax:315-454-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty