Provider Demographics
NPI:1760639157
Name:PRITZ, RANDY FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:FREDERICK
Last Name:PRITZ
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 1:1901 1ST AVE
Mailing Address - Street 2:DENTAL CLINIC 2D3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-423-8977
Mailing Address - Fax:212-423-8495
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:DENTAL CLINIC 2D3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-423-8977
Practice Address - Fax:212-423-8495
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP64281122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice