MEDICARE: UNITED DENTAL SERVICES OF NY

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	0466662	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	:	1558444232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED DENTAL SERVICES OF NY

Provider Business Mailing Address
First Line	:	1505 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	718-336-6321
Fax Number	:	718-627-2129

Provider Business Practice Location Address
First Line	:	1505 GRAVESEND NECK RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	718-336-6321
Fax Number	:	718-627-2129

Authorized Official
Title or Position	:	DENTIST
Name	:	VALENTIN BAXMAN
Credential	:	DDS
Telephone Number	:	718-336-6321

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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Directions to “UNITED DENTAL SERVICES OF NY ” Practice Location

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