Organization
EASTSIDE FAMILY DENTAL OF FAIRPORT, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ALTOBELLI (OFFICE MANAGER)
(585) 223-5010
Entity
Organization
Contact information
Practice address
302 CROSS KEYS OFFICE PARK, FAIRPORT, NY 14450-3511
(585) 223-5010
Mailing address
302 CROSS KEYS OFFICE PARK, FAIRPORT, NY 14450-3511
(585) 223-5010
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851482988
NPI
NY
Enumeration date
05/14/2021
Last updated
05/14/2021
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