Individual
DR. BRIAN MICHAEL KETOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
580 5TH AVE, BROOKLYN, NY 11215
(718) 768-8400
(718) 369-3028
Mailing address
6 BERING CT, WOODBURY, NY 11797
(516) 978-2176
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
035400
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00532958
—
NY
01
—
035400
STATE LICENSE
NY
Enumeration date
09/20/2006
Last updated
03/07/2023
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