Provider Demographics
NPI:1699860155
Name:GUBER, ALAN JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:GUBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LAKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3915
Mailing Address - Country:US
Mailing Address - Phone:914-961-3324
Mailing Address - Fax:914-961-2237
Practice Address - Street 1:107 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3915
Practice Address - Country:US
Practice Address - Phone:914-961-3324
Practice Address - Fax:914-961-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice