MEDICARE: 8TH AVENUE DENTAL OFFICE

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	261QD0000X	Dental Clinic/Center		NY

General Provider Information

NPI Number	:	1154593887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	8TH AVENUE DENTAL OFFICE

Provider Business Mailing Address
First Line	:	5610 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3510
Country	:	US
Telephone Number	:	718-436-1339
Fax Number	:	718-436-1342

Provider Business Practice Location Address
First Line	:	5610 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3510
Country	:	US
Telephone Number	:	718-436-1339
Fax Number	:	718-436-1342

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VALERY DUBOVIKOV
Credential	:	DDS
Telephone Number	:	718-436-1339

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	04/02/2008

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Directions to “8TH AVENUE DENTAL OFFICE ” Practice Location

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