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General NPI Number Information
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NPI Number | 1427336866
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLE DENTAL ASSOCIATES
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 7000 E GENESEE ST BUILDING D
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1131
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Country | US
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Telephone | 315-445-1321
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Fax | 315-445-1399
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Provider Business Mailing Address
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Address Line | 7000 EAST GENESEE STREET BUILDING D
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City | FAYETTEVILLE
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State | NY
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Zip | 13066
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Country | US
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Telephone | 315-445-1321
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Fax | 315-445-1399
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JENNIFER MICHELLE JANOWSKI
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Credential |
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Telephone | 315-409-5290
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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 |
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License Number State | NY
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