NPIMap

Organization Active NPI

Fondak Dental Offices, P.C.

  • Prosthodontics
  • Carthage, NY
National Provider Identifier
1659458677
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
033273 Issued in NY
Legal business name
FONDAK DENTAL OFFICES, P.C.
Practice address
33054 State Route 26
Carthage, NY 13619-8600
Phone
(315) 493-9393
Fax
(315) 493-9394
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jeffrey Theodore Fondak, D.D.S.NPI 1184730392
Title
President
Phone
(315) 493-9393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X 033273 NY Primary

Addresses

Primary practice location

33054 State Route 26
Carthage, NY 13619-8600

Mailing address

33054 State Route 26
Carthage, NY 13619-8600
Phone (315) 493-9393

Other identifiers 4

IdentifierTypeStateIssuer
1640915OtherNYUNITED CONCORDIA GRP NUM
033273OtherNYNYS DENTAL LICENSE
1342155OtherNYUNITED CONCORDIA IND PROV
1184730392OtherNYNPI INDIVIDUAL NUMBER

Other names 1

  • Fondak Dental Offices, P.C. Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659458677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33054 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": "315-493-9393",
            "fax_number": "315-493-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONDAK DENTAL OFFICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FONDAK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-493-9393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "NY",
            "license": "033273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA GRP NUM",
            "identifier": "1640915",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS DENTAL LICENSE",
            "identifier": "033273",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA IND PROV",
            "identifier": "1342155",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL NUMBER",
            "identifier": "1184730392",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fondak Dental Offices, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.