Provider Demographics
NPI:1962504696
Name:WASSERMAN, STEVEN VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:VICTOR
Last Name:WASSERMAN
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 1:17111 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2718
Mailing Address - Country:US
Mailing Address - Phone:718-463-1970
Mailing Address - Fax:718-463-1971
Practice Address - Street 1:17111 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2718
Practice Address - Country:US
Practice Address - Phone:718-463-1970
Practice Address - Fax:718-463-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist