Organization
FAYETTEVILLE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MICHELLE JANOWSKI (OFFICE MANAGER)
(315) 409-5290
Entity
Organization
Contact information
Practice address
7000 E GENESEE ST, BUILDING D, FAYETTEVILLE, NY 13066-1131
(315) 445-1321
(315) 445-1399
Mailing address
7000 EAST GENESEE STREET, BUILDING D, FAYETTEVILLE, NY 13066
(315) 445-1321
(315) 445-1399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00461138
—
NY
Enumeration date
08/03/2011
Last updated
08/03/2011
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