Provider Demographics
NPI:1821227232
Name:PUTERMAN, ISRAEL (DMD MSD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:PUTERMAN
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 712
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-652-0939
Mailing Address - Fax:301-652-0967
Practice Address - Street 1:5454 WISCONSIN AVE STE 1550
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6954
Practice Address - Country:US
Practice Address - Phone:301-652-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206331223P0300X
NY0539391223P0300X
VA04014122651223P0300X
DCDEN10007961223P0300X
MD144011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics