Healthcare Provider Details

I. General information

NPI: 1538226675
Provider Name (Legal Business Name): HOWARD I DEUTSCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MAIN AVE
PASSAIC NJ
07055-5442
US

IV. Provider business mailing address

172 MAIN AVE
PASSAIC NJ
07055-5442
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-0340
  • Fax: 973-473-8073
Mailing address:
  • Phone: 973-473-0340
  • Fax: 973-473-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number11747
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: