Provider Demographics
NPI:1003089715
Name:MARC B. HERTZ, DDS, PC
Entity type:Organization
Organization Name:MARC B. HERTZ, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-998-9999
Mailing Address - Street 1:83 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2402
Mailing Address - Country:US
Mailing Address - Phone:516-295-2920
Mailing Address - Fax:
Practice Address - Street 1:2026 OCEAN AVE
Practice Address - Street 2:SUITE 1K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7352
Practice Address - Country:US
Practice Address - Phone:718-998-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046617261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery