Provider Demographics
NPI:1548301526
Name:POMERANTZ, MARC S (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 BROADWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5012
Mailing Address - Country:US
Mailing Address - Phone:516-541-5545
Mailing Address - Fax:
Practice Address - Street 1:549 BROADWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5012
Practice Address - Country:US
Practice Address - Phone:516-541-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice