MEDICARE: DR. ARISTIDES D ROTSOS D.M.D.

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	048154	NY

General Provider Information

NPI Number	:	1518956168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARISTIDES D ROTSOS D.M.D.

Provider Business Mailing Address
First Line	:	2302 29TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2805
Country	:	US
Telephone Number	:	718-932-6666
Fax Number	:	718-932-9447

Provider Business Practice Location Address
First Line	:	2302 29TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2805
Country	:	US
Telephone Number	:	718-932-6666
Fax Number	:	718-932-9447

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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