Provider Demographics
NPI:1306841754
Name:KALMAN, DORON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORON
Middle Name:
Last Name:KALMAN
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 1:6070 WOODHAVEN BLVD
Mailing Address - Street 2:MEDICAL UNIT C-2
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5554
Mailing Address - Country:US
Mailing Address - Phone:718-897-6400
Mailing Address - Fax:718-997-9710
Practice Address - Street 1:6070 WOODHAVEN BLVD
Practice Address - Street 2:MEDICAL UNIT C-2
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5554
Practice Address - Country:US
Practice Address - Phone:718-897-6400
Practice Address - Fax:718-997-9710
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02122521Medicaid