Organization
GREGG FADER DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGG FADER DMD (OWNER)
(212) 475-0051
Entity
Organization
Contact information
Practice address
504 GRAND ST, SUITE M5, NEW YORK, NY 10002-4182
(212) 475-0051
(212) 475-3279
Mailing address
504 GRAND ST, SUITE M5, NEW YORK, NY 10002-4182
(212) 475-0051
(212) 475-3279
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
040972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01259301
—
NY
Enumeration date
04/08/2014
Last updated
04/08/2014
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