Provider Demographics
NPI:1578898623
Name:BLUMENTHAL, MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:BLUMENTHAL
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 1:22024 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2020
Mailing Address - Country:US
Mailing Address - Phone:718-479-7100
Mailing Address - Fax:718-479-1556
Practice Address - Street 1:22024 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2020
Practice Address - Country:US
Practice Address - Phone:718-479-7100
Practice Address - Fax:718-479-1556
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist