Provider Demographics
NPI:1942281704
Name:BLUMENTHAL, PETER DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:BLUMENTHAL
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 1:34-37 21ST ST
Mailing Address - Street 2:BLUMENTHAL & ASSOCIATES DDS PC
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:718-786-8667
Mailing Address - Fax:718-786-8531
Practice Address - Street 1:34-37 21ST ST
Practice Address - Street 2:BLUMENTHAL & ASSOCIATES DDS PC
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-786-8667
Practice Address - Fax:718-786-8531
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606877Medicaid