Provider Demographics
NPI:1548328545
Name:KARDON, BRIAN PETER (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PETER
Last Name:KARDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 HENRY HUDSON PKWY
Mailing Address - Street 2:#3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3212
Mailing Address - Country:US
Mailing Address - Phone:646-337-6769
Mailing Address - Fax:
Practice Address - Street 1:233 LAFAYETTE AVE
Practice Address - Street 2:211
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4821
Practice Address - Country:US
Practice Address - Phone:845-369-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY481681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics