Provider Demographics
NPI:1174547152
Name:CONDRY, JAMES D (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:CONDRY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WINDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6488
Mailing Address - Country:US
Mailing Address - Phone:518-588-8589
Mailing Address - Fax:
Practice Address - Street 1:458 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5532
Practice Address - Country:US
Practice Address - Phone:518-793-9424
Practice Address - Fax:518-793-9441
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0482431122300000X
NY2144721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02856504Medicaid
NY02856499Medicaid