Provider Demographics
NPI:1437171915
Name:ADLER, SIDNEY L (DDS, FAGD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:L
Last Name:ADLER
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W 239TH ST
Mailing Address - Street 2:C/O RIVERDALE ORAL HEALTH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1211
Mailing Address - Country:US
Mailing Address - Phone:718-548-3353
Mailing Address - Fax:718-548-5064
Practice Address - Street 1:611 W 239TH ST
Practice Address - Street 2:C/O RIVERDALE ORAL HEALTH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1211
Practice Address - Country:US
Practice Address - Phone:718-548-3353
Practice Address - Fax:718-548-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice