Provider Demographics
NPI:1538306204
Name:COUNTY DENTAL AT FISHKILL
Entity Type:Organization
Organization Name:COUNTY DENTAL AT FISHKILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-897-2097
Mailing Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 233
Mailing Address - Street 2:BLDG. 2 SUITE 233
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2268
Mailing Address - Country:US
Mailing Address - Phone:845-897-2097
Mailing Address - Fax:845-897-2240
Practice Address - Street 1:200 WESTAGE BUSINESS CTR DR STE 233
Practice Address - Street 2:BLDG. 2 SUITE 233
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2268
Practice Address - Country:US
Practice Address - Phone:845-897-2097
Practice Address - Fax:845-897-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047222-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty