| Lockport Dental Group Pc D/b/s Medina Dental Group | |
|
610 Park Ave Medina NY 14103-1022 | |
| (585) 798-0100 | |
| (585) 798-3297 |
| Full Name | Lockport Dental Group Pc D/b/s Medina Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 610 Park Ave, Medina, New York |
| Authorized Official Name and Position | Jonathan Barry Stockton (OWNER/DENTIST) |
| Authorized Official Contact | 5857980100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lockport Dental Group Pc D/b/s Medina Dental Group 610 Park Ave Medina NY 14103-1022 Ph: (585) 798-0100 | Lockport Dental Group Pc D/b/s Medina Dental Group 610 Park Ave Medina NY 14103-1022 Ph: (585) 798-0100 |
| NPI Number | 1639576697 |
|---|---|
| Provider Enumeration Date | 11/19/2014 |
| Last Update Date | 11/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639576697 | NPI | - | NPPES |
| 1497830483 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 32240 (New York) | Primary |
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