Provider Demographics
NPI:1891151841
Name:HARRIMAN FAMILY DENTAL
Entity type:Organization
Organization Name:HARRIMAN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-783-6466
Mailing Address - Street 1:96 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3316
Mailing Address - Country:US
Mailing Address - Phone:845-783-6466
Mailing Address - Fax:845-783-6468
Practice Address - Street 1:96 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3316
Practice Address - Country:US
Practice Address - Phone:845-783-6466
Practice Address - Fax:845-783-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty