| Fayetteville Smiles Dentistry Pllc | |
|
5009 Campuswood Dr East Syracuse NY 13057-1222 | |
| (315) 329-5146 | |
| (315) 400-0906 |
| Full Name | Fayetteville Smiles Dentistry Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5009 Campuswood Dr, East Syracuse, New York |
| Authorized Official Name and Position | Daniel Richter (OWNER) |
| Authorized Official Contact | 3153295146 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville Smiles Dentistry Pllc 5009 Campuswood Dr East Syracuse NY 13057-1222 Ph: (315) 329-5146 | Fayetteville Smiles Dentistry Pllc 5009 Campuswood Dr East Syracuse NY 13057-1222 Ph: (315) 329-5146 |
| NPI Number | 1508471046 |
|---|---|
| Provider Enumeration Date | 09/11/2020 |
| Last Update Date | 04/09/2023 |
| Medicare PECOS PAC ID | 9537573076 |
|---|---|
| Medicare Enrollment ID | O20210125002715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508471046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Germain Jean-charles |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1912216789 PECOS PAC ID: 5597061606 Enrollment ID: I20200506000114 |
| Provider Name | Ajay R Kashi |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1225260383 PECOS PAC ID: 8022397272 Enrollment ID: I20210318000883 |
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