Marissa Nicole Fabros, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

063939 Issued in NY

Practice address

149 Hurley Ave
Kingston, NY 12401-2811

Phone

(845) 237-5053

NPI assigned

Sep 5, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1245065689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012811",
            "telephone_number": "845-237-5053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "NY",
            "postal_code": "125341045",
            "country_code": "US",
            "telephone_number": "518-543-9529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FABROS",
        "first_name": "MARISSA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NY",
            "license": "063939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Kingston, NY
• Providers in Kingston, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.