Provider Demographics
NPI:1720148430
Name:FUENTES, FRANCISCO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PLEASANT ST APT 9B-2
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1729
Mailing Address - Country:US
Mailing Address - Phone:518-651-4138
Mailing Address - Fax:
Practice Address - Street 1:133 PARK STREET
Practice Address - Street 2:ALICE HYDE DENTAL CENTER
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-481-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050938-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist