Provider Demographics
NPI:1104929132
Name:MALTZ, SETH LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:LAWRENCE
Last Name:MALTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:955 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8416
Mailing Address - Country:US
Mailing Address - Phone:718-272-8300
Mailing Address - Fax:718-272-3978
Practice Address - Street 1:955 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8416
Practice Address - Country:US
Practice Address - Phone:718-272-8300
Practice Address - Fax:718-272-3978
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0458151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery