Provider Demographics
NPI:1437204211
Name:TROTTER, NATHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:TROTTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:SUITE 12-C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-625-2116
Mailing Address - Fax:718-624-1582
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:SUITE 12-C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-625-2116
Practice Address - Fax:718-624-1582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist