Provider Demographics
NPI:1538985809
Name:MAIN STREET FISHKILL DENTAL, PLLC
Entity type:Organization
Organization Name:MAIN STREET FISHKILL DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-430-9394
Mailing Address - Street 1:887 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2254
Mailing Address - Country:US
Mailing Address - Phone:845-896-8000
Mailing Address - Fax:
Practice Address - Street 1:887 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2254
Practice Address - Country:US
Practice Address - Phone:845-896-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty