Provider Demographics
NPI:1669461638
Name:BREMER, ERIC WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:BREMER
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 1:601 FRANKLIN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5795
Mailing Address - Country:US
Mailing Address - Phone:516-739-7669
Mailing Address - Fax:516-739-7670
Practice Address - Street 1:601 FRANKLIN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5795
Practice Address - Country:US
Practice Address - Phone:516-739-7669
Practice Address - Fax:516-739-7670
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics