Provider Demographics
NPI:1699766899
Name:TRAGER, ROBERT MAXWELL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MAXWELL
Last Name:TRAGER
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 1:14 S SERVICE ROAD
Mailing Address - Street 2:JFK INT'L AIRPORT
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11430
Mailing Address - Country:US
Mailing Address - Phone:718-656-4747
Mailing Address - Fax:718-656-2614
Practice Address - Street 1:111-02 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11412
Practice Address - Country:US
Practice Address - Phone:718-454-3442
Practice Address - Fax:718-454-3888
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026753122300000X
MA10531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00289845Medicaid