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General NPI Number Information
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NPI Number | 1992249122
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Entity Type | Organization
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Legal Business Name | WOODBURY FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 505 STATE ROUTE 208 SUITE 23
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City | MONROE
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State | NY
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Zip | 10950-1608
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Country | US
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Telephone | 845-782-1800
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Fax | 845-782-3116
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Provider Business Mailing Address
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Address Line | 505 STATE ROUTE 208 SUITE 23
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City | MONROE
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State | NY
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Zip | 10950-1608
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Country | US
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Telephone | 845-782-1800
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Fax | 845-782-3116
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CATHY LEWIS
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Credential |
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Telephone | 845-782-1800
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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 | 045825
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License Number State | NY
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