Fayetteville Smiles Dentistry PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FAYETTEVILLE SMILES DENTISTRY PLLC

Practice address

5009 Campuswood Dr
East Syracuse, NY 13057-1222

Phone

(315) 329-5146

Fax

(315) 400-0906

NPI assigned

Sep 11, 2020

Organization subpart

No

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

Authorized official

Name

Daniel RichterNPI 1689830200

Title

Owner

Phone

(315) 329-5146

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Daniel Moss Richter, DMD

  • General Practice Dentistry
  • Troy, NY
  • NPI 1689830200
  NPD Authorized official
• Imad Khan, D.D.S

  • Dentist
  • Irving, TX
  • NPI 1801158829
  NPD (past)

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680998400000",
    "number": "1508471046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5009 CAMPUSWOOD DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571222",
            "telephone_number": "315-329-5146",
            "fax_number": "315-400-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5009 CAMPUSWOOD DR",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571222",
            "telephone_number": "315-329-5146",
            "fax_number": "315-400-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE SMILES DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2023-04-09",
        "certification_date": "2023-04-09",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-329-5146"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Christopher Evans, DPT
• Tricia A Eveleigh, NP
• Karen Marie Evertz, OTR/L
• Judith Hunter Fager, PHD, RN, PMHNP
• Familycare Haven LLC
• Jacqueline Ann Feneran
• Patricia A Fey, MS ED
• Michael Fiacco, MD
• Paul Anthony Fiacco, M.D.
• Tiffany C Fialkovic, MS, OTR/L

• Dental Clinic/Center in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2023; 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.