MEDICARE: CITYWIDE DENTAL CARE PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1164897674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYWIDE DENTAL CARE PC

Provider Business Mailing Address
First Line	:	2865 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1817
Country	:	US
Telephone Number	:	718-338-3487
Fax Number	:	718-338-6389

Provider Business Practice Location Address
First Line	:	2865 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1817
Country	:	US
Telephone Number	:	718-338-3487
Fax Number	:	718-338-6389

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANNA SHNAYDERMAN
Credential	:	DDS
Telephone Number	:	718-338-3487

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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