Provider Demographics
NPI:1922348150
Name:ROCHESTER FAMILY DENTAL
Entity Type:Organization
Organization Name:ROCHESTER FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-271-4700
Mailing Address - Street 1:2024 W HENRIETTA RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1355
Mailing Address - Country:US
Mailing Address - Phone:585-271-4700
Mailing Address - Fax:
Practice Address - Street 1:2024 W HENRIETTA RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1355
Practice Address - Country:US
Practice Address - Phone:585-271-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00426917Medicaid