Healthcare Provider Details

I. General information

NPI: 1043346042
Provider Name (Legal Business Name): FRANSISCUS XAVERIUS DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHELDON DRIVE
KERHONKSON NY
12446
US

IV. Provider business mailing address

PO BOX 237
KERHONKSON NY
12446-0237
US

V. Phone/Fax

Practice location:
  • Phone: 845-626-7370
  • Fax:
Mailing address:
  • Phone: 845-626-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051359
License Number StateNY

VIII. Authorized Official

Name: DR. FRANSISCUS XAVERIUS
Title or Position: MEMBER OWNER
Credential: D.D.S.
Phone: 845-626-7370