Provider Demographics
NPI:1437773264
Name:TEICHER, ROSS MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:MICHAEL
Last Name:TEICHER
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 1:6611 99TH ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4360
Mailing Address - Country:US
Mailing Address - Phone:732-331-5303
Mailing Address - Fax:
Practice Address - Street 1:6611 99TH ST STE 1E
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4360
Practice Address - Country:US
Practice Address - Phone:732-331-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0618631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program