Provider Demographics
NPI:1740458884
Name:KREISMAN, BURT R (DDS)
Entity type:Individual
Prefix:DR
First Name:BURT
Middle Name:R
Last Name:KREISMAN
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 1:1705 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1634
Mailing Address - Country:US
Mailing Address - Phone:516-599-4446
Mailing Address - Fax:516-599-1996
Practice Address - Street 1:1705 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1634
Practice Address - Country:US
Practice Address - Phone:516-599-4446
Practice Address - Fax:516-599-1996
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist