MEDICARE: 34TH STREET DENTAL ASSOCIATES 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	037532	NY

General Provider Information

NPI Number	:	1871618512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	34TH STREET DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	145 GOLF VIEW DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2820
Country	:	US
Telephone Number	:	516-433-2078
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 W 35TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-1904
Country	:	US
Telephone Number	:	212-564-8164
Fax Number	:	212-244-4522

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID SCOTT TARICA
Credential	:	D.M.D.
Telephone Number	:	212-564-8164

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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