Jeffrey Theodore Fondak, D.D.S.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

033273 Issued in NY

Practice address

33054 State Route 26
Carthage, NY 13619-8600

Phone

(315) 493-2106

NPI assigned

Aug 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fondak Dental Offices, P.C.

  • Prosthodontics
  • Carthage, NY
  • NPI 1659458677
  NPD (past) Authorized official
• A Happy Smile Dental Office, PC

  • Dentist
  • Carthage, NY
  • NPI 1861857724
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184730392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33054 NEW YORK STATE ROUTE #26",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136198600",
            "telephone_number": "315-493-9393",
            "fax_number": "315-493-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33054 STATE ROUTE 26",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136198600",
            "telephone_number": "315-493-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDAK",
        "first_name": "JEFFREY",
        "middle_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "033273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "033273",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "1342155",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alain Felix, DDS
• Kaira Lee Fetla
• Kenneth J Fish Sr., D.O.
• Michael Eugene Flaherty, PA
• Fondak Dental Offices, P.C.
• Melissa May Forney, RDN, CDN, LPN, CDCES
• Natashya M. Fraser, DDS
• Morgan Freeman, RN
• Tammy Lynn Gebo, LPN
• Kimberly Michele Ginyard, M.D.

• Prosthodontics in Carthage, NY
• Providers in Carthage, NY by specialty
• Prosthodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.