Provider Demographics
NPI:1104027903
Name:IOTT, MICHAEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:IOTT
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 1:200 E 33RD ST APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4827
Mailing Address - Country:US
Mailing Address - Phone:212-683-1320
Mailing Address - Fax:212-213-1170
Practice Address - Street 1:471 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6021
Practice Address - Country:US
Practice Address - Phone:212-686-2907
Practice Address - Fax:212-213-1170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0345941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice