Provider Demographics
NPI:1710192901
Name:DORFMAN, BETH J (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:J
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PARK AVENUE PERIODONTAL ASSOCIATES
Mailing Address - Street 2:532 PARK AVENUE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-838-0940
Mailing Address - Fax:212-355-4784
Practice Address - Street 1:PARK AVENUE PERIODONTAL ASSOCIATES
Practice Address - Street 2:532 PARK AVENUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-838-0940
Practice Address - Fax:212-355-4784
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133049463OtherFEDERAL TAX ID