Provider Demographics
NPI:1679275119
Name:WASHINGTONVILLE DENTAL GROUP
Entity Type:Organization
Organization Name:WASHINGTONVILLE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-406-4159
Mailing Address - Street 1:674 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2644
Mailing Address - Country:US
Mailing Address - Phone:845-406-4159
Mailing Address - Fax:845-205-2105
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1514
Practice Address - Country:US
Practice Address - Phone:845-496-6622
Practice Address - Fax:845-205-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty