Provider Demographics
NPI:1194916783
Name:TORMA, JONATHAN (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:TORMA
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 1:228 N MAIN ST
Mailing Address - Street 2:CLARKSTOWN DENTAL, PLLC
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5302
Mailing Address - Country:US
Mailing Address - Phone:845-634-8111
Mailing Address - Fax:845-634-8208
Practice Address - Street 1:228 N MAIN ST
Practice Address - Street 2:CLARKSTOWN DENTAL, PLLC
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5302
Practice Address - Country:US
Practice Address - Phone:845-634-8111
Practice Address - Fax:845-634-8208
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist