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General NPI Number Information
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NPI Number | 1285912436
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Entity Type | Organization
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Legal Business Name | PHILMONT FAMILY DENTISTRY,PLLC.
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 1078 ROUTE 217
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City | PHILMONT
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State | NY
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Zip | 12565
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Country | US
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Telephone | 518-672-4077
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Fax | 518-672-4079
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Provider Business Mailing Address
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Address Line | 1078 ROUTE 217 PO BOX 817
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City | PHILMONT
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State | NY
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Zip | 12565
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Country | US
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Telephone | 518-672-4077
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Fax | 518-672-4079
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAREQ KHALIFEH
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Credential | D.D.S
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Telephone | 518-672-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0506461
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License Number State | NY
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