Provider Demographics
NPI:1457679938
Name:GHERMAN, LEE ABRAHAM (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ABRAHAM
Last Name:GHERMAN
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 1:13608 71ST RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1943
Mailing Address - Country:US
Mailing Address - Phone:718-268-4736
Mailing Address - Fax:
Practice Address - Street 1:14128 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1928
Practice Address - Country:US
Practice Address - Phone:718-268-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-09
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist