Provider Demographics
NPI:1306181235
Name:WOODBURY FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:WOODBURY FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWEIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-782-1800
Mailing Address - Street 1:118 RIVER RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3021
Mailing Address - Country:US
Mailing Address - Phone:845-782-1800
Mailing Address - Fax:845-782-3116
Practice Address - Street 1:118 RIVER RD
Practice Address - Street 2:SUITE 14
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3021
Practice Address - Country:US
Practice Address - Phone:845-782-1800
Practice Address - Fax:845-782-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty