Provider Demographics
NPI:1295994713
Name:BIDERMAN, JONATHAN CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CRAIG
Last Name:BIDERMAN
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 1:9019 157TH AVE
Mailing Address - Street 2:APT 8B
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2739
Mailing Address - Country:US
Mailing Address - Phone:718-843-9209
Mailing Address - Fax:718-843-4140
Practice Address - Street 1:9019 157TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2739
Practice Address - Country:US
Practice Address - Phone:516-330-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice