Provider Demographics
NPI:1538243548
Name:VICTOR FAMILY DENTISTRY
Entity type:Organization
Organization Name:VICTOR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOWENGUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-924-3240
Mailing Address - Street 1:277 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1123
Mailing Address - Country:US
Mailing Address - Phone:585-924-3240
Mailing Address - Fax:
Practice Address - Street 1:277 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1123
Practice Address - Country:US
Practice Address - Phone:585-924-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7247OtherBC/BS PROVIDER NUMBER
NY=========OtherTAX ID #
NY=========OtherTAX ID #
NY1639271372Medicare UPIN