Provider Demographics
NPI:1699895359
Name:FEDELE, DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:FEDELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 STUDIO RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-4721
Mailing Address - Country:US
Mailing Address - Phone:203-968-0244
Mailing Address - Fax:914-698-2733
Practice Address - Street 1:444 E BOSTON POST RD STE 208
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3704
Practice Address - Country:US
Practice Address - Phone:914-698-2733
Practice Address - Fax:914-698-2733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036170-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice