Provider Demographics
NPI:1629294111
Name:ERN, CARL FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:FREDERICK
Last Name:ERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2435 ROUTE 6
Mailing Address - Street 2:MIDDLEBRANCH OFFICES
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2537
Mailing Address - Country:US
Mailing Address - Phone:845-279-3720
Mailing Address - Fax:845-279-8144
Practice Address - Street 1:2435 ROUTE 6
Practice Address - Street 2:MIDDLEBRANCH OFFICES
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2537
Practice Address - Country:US
Practice Address - Phone:845-279-3720
Practice Address - Fax:845-279-8144
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0352691223S0112X, 1223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment