Provider Demographics
NPI:1306679469
Name:FAY DENTAL CARE LLC
Entity type:Organization
Organization Name:FAY DENTAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-590-3396
Mailing Address - Street 1:1543 PARK PL STE 600
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1967
Mailing Address - Country:US
Mailing Address - Phone:920-570-9118
Mailing Address - Fax:
Practice Address - Street 1:1543 PARK PL STE 600
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1967
Practice Address - Country:US
Practice Address - Phone:920-570-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty