Provider Demographics
NPI:1821317223
Name:FENSTER, MARC SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:SCOTT
Last Name:FENSTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROUTE 111 STE 212
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3700
Mailing Address - Country:US
Mailing Address - Phone:631-724-6960
Mailing Address - Fax:631-724-6886
Practice Address - Street 1:50 ROUTE 111 STE 212
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3700
Practice Address - Country:US
Practice Address - Phone:631-724-6960
Practice Address - Fax:631-724-6886
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice