Provider Demographics
NPI:1467662114
Name:PLOTKIN, BRADLEY DREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DREW
Last Name:PLOTKIN
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 1:65 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6928
Mailing Address - Country:US
Mailing Address - Phone:845-634-4506
Mailing Address - Fax:845-634-4506
Practice Address - Street 1:65 ROLLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6928
Practice Address - Country:US
Practice Address - Phone:845-634-4506
Practice Address - Fax:845-634-4506
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02576025Medicaid