MEDICARE: SETH L MALTZ DDS PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1417559022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SETH L MALTZ DDS PC

Provider Business Mailing Address
First Line	:	123 LAUREL LN
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-8416
Country	:	US
Telephone Number	:	718-272-8300
Fax Number	:	718-272-3978

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SETH L MALTZ
Credential	:	DDS
Telephone Number	:	646-295-3432

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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