Organization
FAYETTEVILLE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMADEH NOSEGBE DMD (OWNER)
(315) 373-0869
Entity
Organization
Contact information
Practice address
6962 HIGHBRIDGE RD, FAYETTEVILLE, NY 13066-9705
(315) 373-0869
Mailing address
6962 HIGHBRIDGE RD, FAYETTEVILLE, NY 13066-9705
(315) 373-0869
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/08/2020
Last updated
11/08/2020
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