Provider Demographics
NPI:1619976164
Name:WETTAN, HOPE LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:LYNN
Last Name:WETTAN
Suffix:
Gender:F
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:PO BOX 1194
Mailing Address - Street 2:ONE GUSTAVE LEVY PLACE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0313
Mailing Address - Country:US
Mailing Address - Phone:212-241-3985
Mailing Address - Fax:212-534-7491
Practice Address - Street 1:1900 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1724
Practice Address - Country:US
Practice Address - Phone:516-542-1090
Practice Address - Fax:516-794-8165
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046776204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86958Medicare UPIN
NYDE1681Medicare ID - Type Unspecified
CA05D0909730Medicare PIN