Provider Demographics
NPI:1912231556
Name:FAMILY DENTISTRY OF SULLIVAN COUNTY, PLLC
Entity Type:Organization
Organization Name:FAMILY DENTISTRY OF SULLIVAN COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NUCHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-774-9237
Mailing Address - Street 1:P.O. BOX 2022
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779
Mailing Address - Country:US
Mailing Address - Phone:845-434-8444
Mailing Address - Fax:845-434-8440
Practice Address - Street 1:5085 SOUTH FALLSBURG MAIN ST.
Practice Address - Street 2:
Practice Address - City:SOUTH FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12779
Practice Address - Country:US
Practice Address - Phone:845-434-8444
Practice Address - Fax:845-434-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty