Provider Demographics
NPI:1881828176
Name:TRACHTENBERG, EZRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:EZRA
Middle Name:
Last Name:TRACHTENBERG
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 1:135 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5208
Mailing Address - Country:US
Mailing Address - Phone:718-237-7888
Mailing Address - Fax:718-237-8716
Practice Address - Street 1:135 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5208
Practice Address - Country:US
Practice Address - Phone:718-237-7888
Practice Address - Fax:718-237-8716
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice