Healthcare Provider Details

I. General information

NPI: 1447251665
Provider Name (Legal Business Name): DWIGHT L HERSHMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 65TH ST
BROOKLYN NY
11204-4170
US

IV. Provider business mailing address

2469 65TH ST
BROOKLYN NY
11204-4170
US

V. Phone/Fax

Practice location:
  • Phone: 718-382-9399
  • Fax:
Mailing address:
  • Phone: 718-382-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number35001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: