Provider Demographics
NPI:1083074017
Name:ORGEL, IRA (DDS)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:ORGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 69TH AVE
Mailing Address - Street 2:SUITE 112A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3372
Mailing Address - Country:US
Mailing Address - Phone:718-830-0209
Mailing Address - Fax:
Practice Address - Street 1:10505 69TH AVE
Practice Address - Street 2:SUITE 112A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3372
Practice Address - Country:US
Practice Address - Phone:718-830-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040486-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist