Provider Demographics
NPI:1205014792
Name:ADELBERG, MARC T (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:T
Last Name:ADELBERG
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:62 LAKE AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1094
Mailing Address - Country:US
Mailing Address - Phone:631-360-7337
Mailing Address - Fax:631-360-3815
Practice Address - Street 1:62 LAKE AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1094
Practice Address - Country:US
Practice Address - Phone:631-360-7337
Practice Address - Fax:631-360-3815
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY04742311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry