Healthcare Provider Details

I. General information

NPI: 1174079743
Provider Name (Legal Business Name): FREDERICK R FAUSTINI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 ROUTE 22
CROTON FALLS NY
10519
US

IV. Provider business mailing address

597 ROUTE 22
CROTON FALLS NY
10519
US

V. Phone/Fax

Practice location:
  • Phone: 914-277-9919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number042337
License Number StateNY

VIII. Authorized Official

Name: FREDERICK FAUSTINI
Title or Position: OWNER
Credential: DDS
Phone: 914-277-9919