Provider Demographics
NPI:1841387172
Name:DAVID, ETHAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:A
Last Name:DAVID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 HENRY HUDSON PKWY.
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-601-2685
Mailing Address - Fax:718-601-8529
Practice Address - Street 1:2735 HENRY HUDSON PKWY.
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-601-2685
Practice Address - Fax:718-601-8529
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice