MEDICARE: HARMONY DENTAL STUDIO PLLC

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

General Provider Information

NPI Number	:	1649785304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMONY DENTAL STUDIO PLLC

Provider Business Mailing Address
First Line	:	622 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4132
Country	:	US
Telephone Number	:	718-376-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4132
Country	:	US
Telephone Number	:	718-376-0707
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DONNA FONTE
Credential	:
Telephone Number	:	718-382-0707

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	12/04/2017

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