MEDICARE: OCEAN AVE FAMILY DENTAL PC

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	044283	NY

General Provider Information

NPI Number	:	1649526294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN AVE FAMILY DENTAL PC

Provider Business Mailing Address
First Line	:	2001 AVENUE P APT A4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1420
Country	:	US
Telephone Number	:	718-951-2261
Fax Number	:	718-951-2018

Provider Business Practice Location Address
First Line	:	2001 AVENUE P APT A4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1420
Country	:	US
Telephone Number	:	718-951-2261
Fax Number	:	718-951-2018

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IOSIF UVAYDOV
Credential	:	044283
Telephone Number	:	718-951-2261

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	08/01/2012

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