Healthcare Provider Details

I. General information

NPI: 1992864151
Provider Name (Legal Business Name): GARY PAUL ORENTLICHER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CENTRAL PARK AVE SUITE 201
SCARSDALE NY
10583-1068
US

IV. Provider business mailing address

495 CENTRAL PARK AVE SUITE 201
SCARSDALE NY
10583-1068
US

V. Phone/Fax

Practice location:
  • Phone: 914-472-0100
  • Fax: 914-472-1563
Mailing address:
  • Phone: 914-472-0100
  • Fax: 914-472-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number039025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: