=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063946952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBEE FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2017
-----------------------------------------------------
Last Update Date | 08/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1081 LONG POND RD SUITE 120
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-225-8010
-----------------------------------------------------
Fax | 585-621-5534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1081 LONG POND RD SUITE 120
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-225-8010
-----------------------------------------------------
Fax | 585-621-5534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | DR. JENNIFER ROSE ALBEE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 585-225-8010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 043311
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 049076
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------