MEDICARE: RENA KRAVITZ 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	1223P0221X	Pediatric Dentistry	037837-1	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	:	1699761411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENA KRAVITZ D.D.S.

Provider Business Mailing Address
First Line	:	1429 E 16TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6607
Country	:	US
Telephone Number	:	718-376-3676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1337
Country	:	US
Telephone Number	:	718-871-9111
Fax Number	:	718-871-9097

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/30/2015

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