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Organization
PINE BUSH DENTAL GROUP
Active
Organization
PINE BUSH DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC FABER (OWNER/DDS)
(845) 744-5422
Entity
Organization
Contact information
Practice address
2412 ROUTE 52, PINE BUSH, NY 12566-7037
(845) 744-5422
Mailing address
809 STATE ROUTE 208, MONROE, NY 10950-1829
(845) 782-5040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
055718
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3399442
—
NY
Enumeration date
02/28/2017
Last updated
02/28/2017
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