Provider Demographics
NPI:1033343413
Name:IDENT DENTAL AT FISHKILL
Entity Type:Organization
Organization Name:IDENT DENTAL AT FISHKILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOSATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-433-6820
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:SUITE 233
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2264
Mailing Address - Country:US
Mailing Address - Phone:888-433-6820
Mailing Address - Fax:
Practice Address - Street 1:200 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:SUITE 233
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2264
Practice Address - Country:US
Practice Address - Phone:914-245-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483281223E0200X
NY0517321223P0300X
NY0499671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty