Provider Demographics
NPI:1255540878
Name:WASHINGTON FAMILY DENTAL P.C.
Entity type:Organization
Organization Name:WASHINGTON FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-785-1027
Mailing Address - Street 1:15 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5304
Mailing Address - Country:US
Mailing Address - Phone:607-785-1027
Mailing Address - Fax:607-785-0269
Practice Address - Street 1:15 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5304
Practice Address - Country:US
Practice Address - Phone:607-785-1027
Practice Address - Fax:607-785-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN046818OtherDENTIST