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General NPI Number Information
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NPI Number | 1679275119
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Entity Type | Organization
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Legal Business Name | WASHINGTONVILLE DENTAL GROUP
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 32 SOUTH ST
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City | WASHINGTONVILLE
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State | NY
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Zip | 10992-1514
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Country | US
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Telephone | 845-496-6622
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Fax | 845-205-2105
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Provider Business Mailing Address
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Address Line | 674 E MAIN ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2644
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Country | US
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Telephone | 845-406-4159
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Fax | 845-205-2105
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSEPH FABER
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Credential | DDS
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Telephone | 845-406-4159
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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 |
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License Number State |
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