Provider Demographics
NPI:1558326397
Name:FABIANO, JUDE ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:ARTHUR
Last Name:FABIANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4619
Mailing Address - Country:US
Mailing Address - Phone:716-839-5376
Mailing Address - Fax:
Practice Address - Street 1:175 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2231
Practice Address - Country:US
Practice Address - Phone:716-869-1001
Practice Address - Fax:716-691-2283
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist