Provider Demographics
NPI:1760566921
Name:BRISMAN, DAVID L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BRISMAN
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 1:50 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1134
Mailing Address - Country:US
Mailing Address - Phone:201-266-4117
Mailing Address - Fax:
Practice Address - Street 1:31 WASHINGTON SQ. WEST
Practice Address - Street 2:SUITE 1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-673-6900
Practice Address - Fax:212-254-7356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics