| Organization Name: | RONDOUT VALLEY FAMILY DENTISTRY |
| NPI Number: | 1548540800 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WAYNE WILLIAM ST. HILL (PRESIDENT) |
| Mailing Address: | 10 Gagnon Drive Stone Ridge |
| State: | NY US |
| Postal Code: | 12484 |
| Phone Number: | 8456870600 |
| Fax Number: | 8456877296 |
| NPI Enumeration Date: | 08/18/2011 |
| NPI Last Update Date: | 08/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 034680 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |