Provider Demographics
NPI:1215732508
Name:DAVID L BRISMAN DMD PC
Entity type:Organization
Organization Name:DAVID L BRISMAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-673-6900
Mailing Address - Street 1:31 WASHINGTON SQ W APT 1R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9172
Mailing Address - Country:US
Mailing Address - Phone:212-673-6900
Mailing Address - Fax:212-254-7356
Practice Address - Street 1:31 WASHINGTON SQ W APT 1R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9172
Practice Address - Country:US
Practice Address - Phone:212-673-6900
Practice Address - Fax:212-254-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831896588OtherDENTAL
NY1760566921OtherDENTAL