Provider Demographics
NPI:1649307083
Name:FRONT ST DENTAL SERVICES PC DR ROSS BEDERMAN
Entity type:Organization
Organization Name:FRONT ST DENTAL SERVICES PC DR ROSS BEDERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-794-0050
Mailing Address - Street 1:1952 HEMPSTEAD TPKE
Mailing Address - Street 2:FRONT STREET DENTAL SERVICES PC
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1712
Mailing Address - Country:US
Mailing Address - Phone:516-794-0050
Mailing Address - Fax:516-794-4577
Practice Address - Street 1:1941 FRONT STREET
Practice Address - Street 2:FRONT STREET DENTAL SERVICES PC
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-794-0050
Practice Address - Fax:516-794-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty