Provider Demographics
NPI:1417480740
Name:FAIRPORT SMILES DENTISTRY, PC
Entity Type:Organization
Organization Name:FAIRPORT SMILES DENTISTRY, PC
Other - Org Name:CROSSKEYS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BADALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-223-8690
Mailing Address - Street 1:110 CROSS KEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3509
Mailing Address - Country:US
Mailing Address - Phone:585-223-8690
Mailing Address - Fax:585-223-8938
Practice Address - Street 1:110 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3509
Practice Address - Country:US
Practice Address - Phone:585-223-8690
Practice Address - Fax:585-223-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental