Provider Demographics
NPI:1497734651
Name:VERESMORTEAN, NICOLAE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLAE
Middle Name:
Last Name:VERESMORTEAN
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 1:4750 41ST ST
Mailing Address - Street 2:1F
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3648
Mailing Address - Country:US
Mailing Address - Phone:718-472-0061
Mailing Address - Fax:718-472-0061
Practice Address - Street 1:4750 41ST ST
Practice Address - Street 2:1F
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104-3648
Practice Address - Country:US
Practice Address - Phone:718-472-0061
Practice Address - Fax:718-472-0061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist