Provider Demographics
NPI:1679561807
Name:TRATENBERG, LOUIS I (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:TRATENBERG
Suffix:I
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 1:11 BERNADETTE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2704
Mailing Address - Country:US
Mailing Address - Phone:973-379-4465
Mailing Address - Fax:
Practice Address - Street 1:15 JOURNAL SQ
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4006
Practice Address - Country:US
Practice Address - Phone:201-653-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ107241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0658201Medicaid