Provider Demographics
NPI:1366610867
Name:GETZ, EDWIN SALAGER (060939699)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:SALAGER
Last Name:GETZ
Suffix:
Gender:M
Credentials:060939699
Other - Prefix:DR
Other - First Name:EDWIN
Other - Middle Name:SALAGER
Other - Last Name:GETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:060939699
Mailing Address - Street 1:1607 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4716
Mailing Address - Country:US
Mailing Address - Phone:203-323-1888
Mailing Address - Fax:203-325-4125
Practice Address - Street 1:1607 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4716
Practice Address - Country:US
Practice Address - Phone:203-323-1888
Practice Address - Fax:203-325-4125
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048311223G0001X
CT0048411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice