Healthcare Provider Details

I. General information

NPI: 1144903675
Provider Name (Legal Business Name): FARMINGTON DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 STATE ROUTE 332
FARMINGTON NY
14425-9601
US

IV. Provider business mailing address

1637 STATE ROUTE 332
FARMINGTON NY
14425-9601
US

V. Phone/Fax

Practice location:
  • Phone: 585-398-2100
  • Fax: 585-398-3573
Mailing address:
  • Phone: 585-398-2100
  • Fax: 585-398-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISSY DEVEY
Title or Position: FRONT DESK
Credential:
Phone: 585-398-2100