MEDICARE: HOWARD STANLEY DORFMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401004627	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	548527	OTHER	VA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1336235761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD STANLEY DORFMAN DMD

Provider Business Mailing Address
First Line	:	4356 4 BONNEY ROAD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1200
Country	:	US
Telephone Number	:	757-340-7000
Fax Number	:	757-498-6498

Provider Business Practice Location Address
First Line	:	4356 4 BONNEY ROAD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1200
Country	:	US
Telephone Number	:	757-340-7000
Fax Number	:	757-498-6498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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