Organization · Type 2 NPI

Pediatric Dentistry & Interceptive Orthodontics P.c.

Orthodontics and Dentofacial Orthopedics Dentistry · Fayetteville, NY

NPI number 1346300209 Active

Practice location

8016 E Genesee St
Fayetteville, NY 13066-9692

Fax (315) 637-0169

Specialties and licenses

TaxonomyCodeLicense
Pediatric Dentistry 1223P0221X027300 (NY)
Pediatric Dentistry 1223P0221X043434 (NY)
Pediatric Dentistry 1223P0221X038405 (NY)
Orthodontics and Dentofacial Orthopedics Dentistry Primary 1223X0400X050957 (NY)

Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…

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About NPI 1346300209

Pediatric Dentistry & Interceptive Orthodontics P.c.'s National Provider Identifier is 1346300209, issued on Dec 11, 2006. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Fayetteville, NY. The record was last updated on Sep 11, 2025.