Provider Demographics
NPI:1467984229
Name:WASHINGTON FAMILY DENTAL P.C.
Entity Type:Organization
Organization Name:WASHINGTON FAMILY DENTAL P.C.
Other - Org Name:WASHINGTON FAMILY DENTAL P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-785-1027
Mailing Address - Street 1:15 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5354
Mailing Address - Country:US
Mailing Address - Phone:607-785-1027
Mailing Address - Fax:607-785-0269
Practice Address - Street 1:15 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5354
Practice Address - Country:US
Practice Address - Phone:607-785-1027
Practice Address - Fax:607-785-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046818261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental