Healthcare Provider Details

I. General information

NPI: 1023198793
Provider Name (Legal Business Name): ROBERT MARK DOLMAN D.D.S.MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 41ST ST SUITE 1102
NEW YORK NY
10017-6221
US

IV. Provider business mailing address

12 E 41ST ST SUITE 1102
NEW YORK NY
10017-6221
US

V. Phone/Fax

Practice location:
  • Phone: 212-696-0167
  • Fax: 917-463-0296
Mailing address:
  • Phone: 212-696-0167
  • Fax: 917-463-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number054277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: