Provider Demographics
NPI:1255321477
Name:KAUFMAN, RICHARD MARK (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARK
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 GLEN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2782
Mailing Address - Country:US
Mailing Address - Phone:516-671-3755
Mailing Address - Fax:516-671-6453
Practice Address - Street 1:15 GLEN ST
Practice Address - Street 2:STE 205
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2782
Practice Address - Country:US
Practice Address - Phone:516-671-3755
Practice Address - Fax:516-671-6453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY033109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00387971Medicaid