Provider Demographics
NPI:1871706515
Name:LAAFAYETTE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:LAAFAYETTE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-677-3113
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-0259
Mailing Address - Country:US
Mailing Address - Phone:315-677-3113
Mailing Address - Fax:315-677-3114
Practice Address - Street 1:2509 SYRACUSE-CORTLAND RD. RT 11
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-0259
Practice Address - Country:US
Practice Address - Phone:315-677-3113
Practice Address - Fax:315-677-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty