MEDICARE: WOODBURY FAMILY DENTAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	045825	NY

General Provider Information

NPI Number	:	1306181235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBURY FAMILY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	118 RIVER RD
Second Line	:	SUITE 14
City	:	HARRIMAN
State	:	NY
Zip	:	10926-3021
Country	:	US
Telephone Number	:	845-782-1800
Fax Number	:	845-782-3116

Provider Business Practice Location Address
First Line	:	118 RIVER RD
Second Line	:	SUITE 14
City	:	HARRIMAN
State	:	NY
Zip	:	10926-3021
Country	:	US
Telephone Number	:	845-782-1800
Fax Number	:	845-782-3116

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL ZWEIBACH
Credential	:	DDS
Telephone Number	:	845-782-1800

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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