Provider Demographics
NPI:1437138906
Name:KAUFMAN, ROBERT JACK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JACK
Last Name:KAUFMAN
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 1:1314 46TH ST A4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2150
Mailing Address - Country:US
Mailing Address - Phone:718-437-6453
Mailing Address - Fax:646-619-4547
Practice Address - Street 1:1314 46TH ST A4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2150
Practice Address - Country:US
Practice Address - Phone:718-437-6453
Practice Address - Fax:646-619-4547
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0464091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01662555Medicaid