Provider Demographics
NPI:1629595145
Name:GARY FISHBEIN DMD LLC
Entity Type:Organization
Organization Name:GARY FISHBEIN DMD LLC
Other - Org Name:EAST OF THE RIVER ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-872-8331
Mailing Address - Street 1:281 HARTFORD TPKE STE 307
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4707
Mailing Address - Country:US
Mailing Address - Phone:860-872-8331
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE STE 307
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4707
Practice Address - Country:US
Practice Address - Phone:860-872-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT113331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty