MEDICARE: DR. MARC BENJAMIN HERTZ D.D.S.

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)	046617	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952383663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC BENJAMIN HERTZ D.D.S.

Provider Business Mailing Address
First Line	:	1517 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6339
Country	:	US
Telephone Number	:	718-998-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2026 OCEAN AVE
Second Line	:	SUITE 1K
City	:	BROOKLYN
State	:	NY
Zip	:	11230-7352
Country	:	US
Telephone Number	:	718-998-9999
Fax Number	:	718-998-9999

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/18/2008

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