Fayetteville Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FAYETTEVILLE FAMILY DENTISTRY

Practice address

6962 Highbridge Rd
Fayetteville, NY 13066-9705

Phone

(315) 373-0869

NPI assigned

Nov 8, 2020

Last updated

Nov 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Imadeh Nosegbe, DMDNPI 1902860208

Title

Owner

Phone

(315) 373-0869

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Imadeh Rita Nosegbe, DMD

  • Dentist
  • Syracuse, NY
  • NPI 1902860208
  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": "1604793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604793600000",
    "number": "1831790500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6962 HIGHBRIDGE RD",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130669705",
            "telephone_number": "315-373-0869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6962 HIGHBRIDGE RD",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130669705",
            "telephone_number": "315-373-0869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-08",
        "last_updated": "2020-11-08",
        "certification_date": "2020-11-08",
        "status": "A",
        "authorized_official_last_name": "NOSEGBE",
        "authorized_official_first_name": "IMADEH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-373-0869",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlee Anne Fallon, PA-C
• Family Medical Care of Dewitt PLLC
• Sara Lou Farchione, MD
• Fateh Supply Inc
• Fayetteville Dental Associates
• Fayetteville Family Physician, PLLC
• Amin Fazeli, MD
• Samantha Hannah Fehr
• Robert Feldman, MD
• Andrew L Finley, MD

• Dentist in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.