MEDICARE: DR. ALLAN MALTMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	23659	NY

General Provider Information

NPI Number	:	1043223951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN MALTMAN DDS

Provider Business Mailing Address
First Line	:	624 NUTLEY PLACE
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	516-791-5514
Fax Number	:	516-791-7358

Provider Business Practice Location Address
First Line	:	624 NUTLEY PLACE
Second Line	:
City	:	NORTH WOODMERE
State	:	NY
Zip	:	11581
Country	:	US
Telephone Number	:	516-791-5514
Fax Number	:	516-791-7358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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