Provider Demographics
NPI:1942573704
Name:BEDERMAN, ROSS I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:I
Last Name:BEDERMAN
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 1:1941 FRONT ST
Mailing Address - Street 2:FRONT ST DENAL SERVICES P.C.
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-794-0050
Mailing Address - Fax:516-794-4577
Practice Address - Street 1:201 FOREST AVE
Practice Address - Street 2:GLEN COVE DENTAL SERVICE PC
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-609-0800
Practice Address - Fax:516-609-9611
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist