Basic Information
| Provider Information | |||||||||
| NPI: | 1922145465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IANCU | ||||||||
| FirstName: | AUGUSTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
| FaxNumber: | 3154548650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 ALTAMONT AVE | ||||||||
| Address2: | |||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123032137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183563300 | ||||||||
| FaxNumber: | 5183568003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 10/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 050691-1 | NY | Y | Dental Providers | Dentist | General Practice | 122300000X | 016.0059190 | VT | N | Dental Providers | Dentist |
No ID Information.