Provider Demographics
NPI:1508576067
Name:SRETER, ROBERT VICTOR (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VICTOR
Last Name:SRETER
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 1:27 KEREN HAYESOD
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:JERUSALEM
Mailing Address - Zip Code:94188
Mailing Address - Country:IL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 FRANKLIN PL STE A
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1244
Practice Address - Country:US
Practice Address - Phone:516-374-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033236OtherDENTAL LICENSE