Provider Demographics
NPI:1639436876
Name:OAK TREE FAMILY DENTAL
Entity Type:Organization
Organization Name:OAK TREE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-279-7177
Mailing Address - Street 1:2410 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2527
Mailing Address - Country:US
Mailing Address - Phone:845-279-7177
Mailing Address - Fax:845-278-2526
Practice Address - Street 1:2410 RT. 6
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509
Practice Address - Country:US
Practice Address - Phone:845-279-7177
Practice Address - Fax:845-278-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0350711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty