Provider Demographics
NPI:1578656500
Name:FERTEL, VALERIE ROSAMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ROSAMUND
Last Name:FERTEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 QUAKER RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2808
Mailing Address - Country:US
Mailing Address - Phone:914-637-8148
Mailing Address - Fax:
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:914-637-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice