Provider Demographics
NPI:1104985217
Name:FLATOW, EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:FLATOW
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 1:10933 71ST RD
Mailing Address - Street 2:SUITE1C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4850
Mailing Address - Country:US
Mailing Address - Phone:718-253-5813
Mailing Address - Fax:718-793-4995
Practice Address - Street 1:109-33 71ST RD
Practice Address - Street 2:SUITE1C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4850
Practice Address - Country:US
Practice Address - Phone:718-253-5813
Practice Address - Fax:718-793-4995
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0412561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice