Healthcare Provider Details

I. General information

NPI: 1932238649
Provider Name (Legal Business Name): ALVIN BREGMAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 WASHINGTON STREET
WATERTOWN NY
13601
US

IV. Provider business mailing address

531 WASHINGTON STREET
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-4740
  • Fax: 315-788-4228
Mailing address:
  • Phone: 315-788-4740
  • Fax: 315-788-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number024841
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number044613
License Number StateNY

VIII. Authorized Official

Name: DR. ALVIN H BREGMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 315-788-4740