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General NPI Number Information
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NPI Number | 1205853942
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Entity Type | Organization
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Legal Business Name | IRA KREITMAN,DDS,PA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3266
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Country | US
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Telephone | 732-363-4310
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3266
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Country | US
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Telephone | 732-363-4310
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRA KREITMAN
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Credential | D.D.S
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Telephone | 732-363-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22D100768300
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License Number State | NJ
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