Organization
FONDAK DENTAL OFFICES, P.C.
Active
Other names
Fondak Dental Offices, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY THEODORE FONDAK D.D.S. (PRESIDENT)
(315) 493-9393
Entity
Organization
Contact information
Practice address
33054 STATE ROUTE 26, CARTHAGE, NY 13619-8600
(315) 493-9393
(315) 493-9394
Mailing address
33054 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
NYS DENTAL LICENSE
NY
01
—
1184730392
NPI INDIVIDUAL NUMBER
NY
01
—
1342155
UNITED CONCORDIA IND PROV
NY
01
—
1640915
UNITED CONCORDIA GRP NUM
NY
Enumeration date
11/01/2006
Last updated
08/22/2020
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