MEDICARE: DR. JORGE L PANTOJA DMD

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	058516	NY

General Provider Information

NPI Number	:	1750776928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L PANTOJA DMD

Provider Business Mailing Address
First Line	:	170 E MOSHOLU PKWY S APT 7B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1182
Country	:	US
Telephone Number	:	787-453-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 W 183RD ST
Second Line	:	DENTAL OFFICE
City	:	BRONX
State	:	NY
Zip	:	10453-1212
Country	:	US
Telephone Number	:	718-367-4222
Fax Number	:

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

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	01/30/2017

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