MEDICARE: DR. ZACHARY GORDEN D.D.S.

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	043323	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007965	OTHER	NY	DORAL DENTAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	002475	OTHER	NY	EMPIRE BLUE CROSS
4	D000341-01	OTHER	NY	AMERICHOICE OF NEW YORK

General Provider Information

NPI Number	:	1639168727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY GORDEN D.D.S.

Provider Business Mailing Address
First Line	:	4515 15TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2702
Country	:	US
Telephone Number	:	718-437-7094
Fax Number	:	718-437-2907

Provider Business Practice Location Address
First Line	:	1537 51ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3738
Country	:	US
Telephone Number	:	718-437-7094
Fax Number	:	718-437-2907

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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