Provider Demographics
NPI:1043396930
Name:HOLTZMAN, LAWRENCE STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEVEN
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 WATERS PL STE 503
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2732
Mailing Address - Country:US
Mailing Address - Phone:718-824-4200
Mailing Address - Fax:718-824-4201
Practice Address - Street 1:1250 WATERS PL STE 503
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-824-4200
Practice Address - Fax:718-824-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0407111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU28773Medicare UPIN