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General NPI Number Information
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NPI Number | 1457731432
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Entity Type | Individual
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Provider Name | EVAN HERTAN DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 431 59TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2107
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Country | US
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Telephone | 201-223-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 431 59TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 059074
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 059074
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22D102865200
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License Number State | NJ
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