Provider Demographics
NPI:1194948331
Name:SEROTA, MARTIN L (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:SEROTA
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 1:7351 BELL BLVD APT 1F
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2939
Mailing Address - Country:US
Mailing Address - Phone:718-468-1952
Mailing Address - Fax:
Practice Address - Street 1:7351 BELL BLVD APT 1F
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2939
Practice Address - Country:US
Practice Address - Phone:718-468-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist