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NPI Code Detail

MEDICARE: DR. JOHN LAWRENCE FAMA DMD

MEDICARE: DR. JOHN LAWRENCE FAMA DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry043096NY

General Provider Information

NPI Number : 1417046988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN LAWRENCE FAMA DMD
Provider Business Mailing Address
First Line : 62 EMPIRE BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-4356
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 62 EMPIRE BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-4356
Country : US
Telephone Number : 585-482-3533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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