Provider Demographics
NPI:1326124769
Name:DORFMAN, ALLA (DDS)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 BROADWAY
Mailing Address - Street 2:LL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3519
Mailing Address - Country:US
Mailing Address - Phone:212-431-4582
Mailing Address - Fax:212-431-4939
Practice Address - Street 1:402 BROADWAY
Practice Address - Street 2:LL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3519
Practice Address - Country:US
Practice Address - Phone:212-431-4582
Practice Address - Fax:212-431-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051670-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587713Medicaid