MEDICARE: DR. GINA MARIE CUCCHIARA DDS

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	055681	NY

General Provider Information

NPI Number	:	1255610499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA MARIE CUCCHIARA DDS

Provider Business Mailing Address
First Line	:	15120 88TH ST STE LL
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-2034
Country	:	US
Telephone Number	:	718-848-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	15120 88TH ST STE LL
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-2034
Country	:	US
Telephone Number	:	718-848-6177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	02/10/2012

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