Provider Demographics
NPI:1003877358
Name:KAUFMAN, MYRON JOEL (DMD)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:JOEL
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:N VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2706
Mailing Address - Country:US
Mailing Address - Phone:412-823-2001
Mailing Address - Fax:412-823-4022
Practice Address - Street 1:1918 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:N VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2706
Practice Address - Country:US
Practice Address - Phone:412-823-2001
Practice Address - Fax:412-823-4022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019172L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005266860002Medicaid
PA046432OtherUNITED CONCORDIA DENTAL