Fairport Dental, P.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

FAIRPORT DENTAL, P.C.

Practice address

302 Cross Keys Office Park
Fairport, NY 14450-3511

Phone

(585) 223-5010

NPI assigned

Aug 28, 2020

Organization subpart

No

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

Authorized official

Name

Jennifer Altobelli

Title

Office Manager

Phone

(585) 223-5010

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Lisa G Marin, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Augusta, GA
  • NPI 1578659967
  NPD (past)

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1508479684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 CROSS KEYS OFFICE PARK",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503511",
            "telephone_number": "585-223-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CROSS KEYS OFFICE PARK",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503511",
            "telephone_number": "585-223-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRPORT DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "ALTOBELLI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "585-223-5010"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588654826",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jenn@drwaldow.com",
            "affiliation": "N",
            "endpointDescription": "Office Managers Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "302 Cross Keys Office Park",
            "city": "Fairport",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144503511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Ann Fackelman, OTR
• Fairport Baptist Homes
• Fairport Baptist Homes Adult Care Facility
• Fairport Central School District
• Fairport Chiropractic
• Fairport Pediatrics
• Fairport Physical Therapy, PC
• Fairport Psychiatric Associates
• Fairport Smiles Dentistry, PC (CrossKeys Dental)
• Fairport SNF LLC

• Pediatric Dentistry in Fairport, NY
• Providers in Fairport, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; 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.