NPIMap

Organization Active NPI

Monroe Dental Group, LLC

  • Dentist
  • Monroe, NY
National Provider Identifier
1407190333
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
55718 Issued in NY
Legal business name
MONROE DENTAL GROUP, LLC
Practice address
809 State Route 208
Monroe, NY 10950-1829
Phone
(845) 782-5040
Fax
(845) 782-3478
NPI assigned
Nov 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Authorized official

Name
Dr. Marc Faber, DDS
Title
Owner
Phone
(845) 782-5040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 55718 NY Primary

Addresses

Primary practice location

809 State Route 208
Monroe, NY 10950-1829

Mailing address

809 State Route 208
Monroe, NY 10950-1829
Phone (845) 782-5040

Other identifiers 1

IdentifierTypeStateIssuer
3399442MedicaidNY

National Provider Directory

National Provider Directory

Locations

809 State Route 208
Monroe, NY 10950
Phone (845) 782-5040

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1407190333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 STATE ROUTE 208",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109501829",
            "telephone_number": "845-782-5040",
            "fax_number": "845-782-3478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 STATE ROUTE 208",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109501829",
            "telephone_number": "845-782-5040",
            "fax_number": "845-782-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "FABER",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-782-5040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "55718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3399442",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.