MEDICARE: MIDWOOD DENTAL HEALTH ASSOCIATES

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	122300000X	Dentist	038184	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235344417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWOOD DENTAL HEALTH ASSOCIATES

Provider Business Mailing Address
First Line	:	3215 AVENUE H APT 1C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3216
Country	:	US
Telephone Number	:	718-434-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 AVENUE H APT 1C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3216
Country	:	US
Telephone Number	:	718-434-3131
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARVIN BRODY
Credential	:	DDS
Telephone Number	:	718-434-3131

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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