Provider Demographics
NPI:1184726663
Name:BEHM, THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BEHM
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 1:425 E 58TH ST
Mailing Address - Street 2:APT. 7B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2300
Mailing Address - Country:US
Mailing Address - Phone:212-339-0001
Mailing Address - Fax:
Practice Address - Street 1:20 E 68TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5844
Practice Address - Country:US
Practice Address - Phone:212-744-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02146087Medicaid