Provider Demographics
NPI:1962834804
Name:BLEYZER, MICHAEL V (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:BLEYZER
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 1:14 THIELLS MT. IVY RD.
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-429-8060
Mailing Address - Fax:845-429-3570
Practice Address - Street 1:14 THIELLS MOUNT IVY RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3021
Practice Address - Country:US
Practice Address - Phone:845-429-8060
Practice Address - Fax:845-429-3570
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist