Healthcare Provider Details

I. General information

NPI: 1992249122
Provider Name (Legal Business Name): WOODBURY FAMILY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 STATE ROUTE 208 SUITE 23
MONROE NY
10950-1608
US

IV. Provider business mailing address

505 STATE ROUTE 208 SUITE 23
MONROE NY
10950-1608
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-1800
  • Fax: 845-782-3116
Mailing address:
  • Phone: 845-782-1800
  • Fax: 845-782-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number045825
License Number StateNY

VIII. Authorized Official

Name: MRS. CATHY LEWIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-782-1800