Individual
DR. JEFFREY THEODORE FONDAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
33054 STATE ROUTE 26, CARTHAGE, NY 13619-8600
(315) 493-2106
Mailing address
33054 NEW YORK STATE ROUTE #26, CARTHAGE, NY 13619-8600
(315) 493-9393
(315) 493-9394
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
033273
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033273
DENTAL LICENSE
NY
01
—
1342155
UNITED CONCORDIA PROVIDER
—
Enumeration date
08/21/2006
Last updated
07/08/2007
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