Provider Demographics
NPI:1396836557
Name:PITTSFORD FAMILY DENTAL PRACTICE P.C.
Entity Type:Organization
Organization Name:PITTSFORD FAMILY DENTAL PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONNERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-248-5250
Mailing Address - Street 1:3592 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1235
Mailing Address - Country:US
Mailing Address - Phone:585-248-5250
Mailing Address - Fax:585-248-2508
Practice Address - Street 1:3592 MONROE AVE
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1235
Practice Address - Country:US
Practice Address - Phone:585-248-5250
Practice Address - Fax:585-248-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty