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General NPI Number Information
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NPI Number | 1003980095
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Entity Type | Organization
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Legal Business Name | BARRY FENNER DDS PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 831 ROUTE 211 EAST
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City | MIDDLETOWN
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State | NY
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Zip | 10941
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Country | US
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Telephone | 845-692-5311
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Fax | 845-692-6778
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Provider Business Mailing Address
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Address Line | 831 ROUTE 211 EAST BARRY FENNER DDS PC
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City | MIDDLETOWN
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State | NY
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Zip | 10941
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Country | US
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Telephone | 845-692-5311
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Fax | 845-692-6778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BARRY FENNER
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Credential | DDS
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Telephone | 845-692-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 028030
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License Number State | NY
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