Provider Demographics
NPI:1013079920
Name:BACH, HADLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:HADLEY
Middle Name:S
Last Name:BACH
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 1:479 BEATRICE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2508
Mailing Address - Country:US
Mailing Address - Phone:718-863-9733
Mailing Address - Fax:
Practice Address - Street 1:1966 NEWBOLD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5024
Practice Address - Country:US
Practice Address - Phone:718-863-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01011081Medicaid