MEDICARE: BRENTWOOD DENTAL CARE

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	050187	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	:	1922264621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENTWOOD DENTAL CARE

Provider Business Mailing Address
First Line	:	1814 FIFTH AVE
Second Line	:
City	:	BAYSHORE
State	:	NY
Zip	:	11706
Country	:	US
Telephone Number	:	631-273-8111
Fax Number	:	631-434-7764

Provider Business Practice Location Address
First Line	:	1814 5TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1732
Country	:	US
Telephone Number	:	631-273-8111
Fax Number	:	631-434-7764

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	NAYAT BOSTANCI
Credential	:	DDS
Telephone Number	:	631-273-8111

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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Directions to “BRENTWOOD DENTAL CARE ” Practice Location

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