Fondak, Jeffrey Theodore
Fondak, Jeffrey Theodore is an sole proprietor health care provider with primary practice located at 33054 State Route 26 , Carthage NY 13619-8600. He recently has only one registered license in Dental Providers / Prosthodontics, which is considered as his primary health care specialty. Fondak, Jeffrey Theodore can be contacted via phone (315) 493-2106.Contact Information
Primary practice address
33054 State Route 26
Carthage NY 13619-8600
Phone: (315) 493-2106
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Prosthodontics | 1223P0700X | 033273 | New York |
Profile Details
| NPI number | 1184730392 |
|---|---|
| LBN Legal business name | Fondak, Jeffrey Theodore |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 21st, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184730392 | NPPES |
| New York | Other | 033273 | DENTAL LICENSE |
| New York | Other | 1342155 | DENTAL LICENSE |
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