Provider Demographics
NPI:1063581221
Name:DORFMAN, ALAN R (DDS GENERAL)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:DORFMAN
Suffix:
Gender:M
Credentials:DDS GENERAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 OLD COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-334-4848
Mailing Address - Fax:516-333-4747
Practice Address - Street 1:530 OLD COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-334-4848
Practice Address - Fax:516-333-4747
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00811954Medicaid