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NPI Code Detail

MEDICARE: DIRECT DENTAL SERVICES PC

MEDICARE: DIRECT DENTAL SERVICES 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
1122300000XDentist046662NY

General Provider Information

NPI Number : 1912122508
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIRECT DENTAL SERVICES PC
Provider Business Mailing Address
First Line : 1505 GRAVESEND NECK RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11229
Country : US
Telephone Number : 718-336-6321
Fax Number : 718-627-2129
Provider Business Practice Location Address
First Line : 1505 GRAVESEND NECK RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-4428
Country : US
Telephone Number : 718-336-6321
Fax Number : 718-627-2129
Authorized Official
Title or Position : DENTIST
Name : VALENTIN BAKMAN
Credential : DDS
Telephone Number : 718-336-6321
Provider Enumeration Date : 04/17/2007
Last Update Date : 06/18/2008

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Directions to “DIRECT DENTAL SERVICES PC ” Practice Location

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