Healthcare Provider Details

I. General information

NPI: 1912231556
Provider Name (Legal Business Name): FAMILY DENTISTRY OF SULLIVAN COUNTY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 SOUTH FALLSBURG MAIN ST.
SOUTH FALLSBURG NY
12779
US

IV. Provider business mailing address

P.O. BOX 2022
SOUTH FALLSBURG NY
12779
US

V. Phone/Fax

Practice location:
  • Phone: 845-434-8444
  • Fax: 845-434-8440
Mailing address:
  • Phone: 845-434-8444
  • Fax: 845-434-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. NUCHEM FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 845-774-9237