Healthcare Provider Details

I. General information

NPI: 1043351620
Provider Name (Legal Business Name): PAUL W TEPLITSKY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS ST LICH DEPARTMENT OF DENTISTRY
BROOKLYN NY
11201-5509
US

IV. Provider business mailing address

339 HICKS ST LICH DEPARTMENT OF DENTISTRY
BROOKLYN NY
11201-5509
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-4630
  • Fax: 718-780-2981
Mailing address:
  • Phone: 718-780-4630
  • Fax: 718-780-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number035819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: