MEDICARE: BRUCE B. MALTZ 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	045815	NY

General Provider Information

NPI Number	:	1992968135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE B. MALTZ DDS

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

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. SETH MALTZ
Credential	:	D.D.S.
Telephone Number	:	718-272-8300

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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