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NPI Code Detail

MEDICARE: DR. MARTIN BODEK DDS

MEDICARE: DR. MARTIN BODEK DDS
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
11223G0001XGeneral Practice Dentistry040812NY

General Provider Information

NPI Number : 1831250588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARTIN BODEK DDS
Provider Business Mailing Address
First Line : 1491 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-2428
Country : US
Telephone Number : 718-859-3440
Fax Number : 718-859-2313
Provider Business Practice Location Address
First Line : 1491 FLATBUSH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-2428
Country : US
Telephone Number : 718-859-3440
Fax Number : 718-859-2313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARTIN BODEK DDS” Practice Location

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