Provider Demographics
NPI:1427445204
Name:PAUL M HERTZ DMD LLC
Entity type:Organization
Organization Name:PAUL M HERTZ DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:748-432-9900
Mailing Address - Street 1:6011 RIVERDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-432-9900
Mailing Address - Fax:718-432-9903
Practice Address - Street 1:6011 RIVERDALE AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-432-9900
Practice Address - Fax:718-432-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty