Basic Information
| Provider Information | |||||||||
| NPI: | 1619281037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOXCARE DENTAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE FOXCARE DR SUITE 304 | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138202629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6074315323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 NORTON AVE | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138202629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6074315900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2010 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | RYAN | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6074315632 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AURELIA OSBORN FOX MEMORIAL | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 3801000H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00279098 | 05 | NY | MEDICAID |