Provider Demographics
NPI:1659884104
Name:ORANGE COUNTY DENTAL, P.C.
Entity Type:Organization
Organization Name:ORANGE COUNTY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-238-4791
Mailing Address - Street 1:1 PRAG BLVD UNIT 111
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-8448
Mailing Address - Country:US
Mailing Address - Phone:845-238-4794
Mailing Address - Fax:
Practice Address - Street 1:1 PRAG BLVD UNIT 111
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-8448
Practice Address - Country:US
Practice Address - Phone:845-238-4794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3013591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty