Provider Demographics
NPI:1346365715
Name:DOKTORMAN, EDWARD L (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:DOKTORMAN
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 1:1030 CLIFTON AVE
Mailing Address - Street 2:EDWARD DOKTORMAN DDS
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-778-0013
Mailing Address - Fax:973-778-0924
Practice Address - Street 1:1030 CLIFTON AVE
Practice Address - Street 2:EDWARD DOKTORMAN DDS
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-0013
Practice Address - Fax:973-778-0924
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20804122300000X
NY048-371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02289825Medicaid