Individual
DR. GREGG R FADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
504 GRAND STREET, #M3, NEW YORK, NY 10002
(212) 475-0051
(212) 475-3279
Mailing address
ONE JORDAN LANE, ARDSLEY, NY 10502
(914) 693-4442
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
040972
NY
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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