Provider Demographics
NPI:1063420008
Name:DANSVILLE FAMILY DENTAL CARE
Entity type:Organization
Organization Name:DANSVILLE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS-TEACHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-335-6170
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437
Mailing Address - Country:US
Mailing Address - Phone:585-335-6170
Mailing Address - Fax:585-335-5764
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437
Practice Address - Country:US
Practice Address - Phone:585-335-6170
Practice Address - Fax:585-335-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty