Provider Demographics
NPI: | 1942462197 |
---|---|
Name: | ORANGE COUNTY DENTAL SERVICES |
Entity Type: | Organization |
Organization Name: | ORANGE COUNTY DENTAL SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSPEH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FERTUCCI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 845-344-1003 |
Mailing Address - Street 1: | 453 ROUTE 211 E |
Mailing Address - Street 2: | SUITE 103 |
Mailing Address - City: | MIDDLETOWN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10940-2206 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-344-1003 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 453 ROUTE 211 E |
Practice Address - Street 2: | SUITE 103 |
Practice Address - City: | MIDDLETOWN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10940-2206 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-344-1003 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-06-30 |
Last Update Date: | 2008-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 047222 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |