MEDICARE: WOODBURY FAMILY DENTAL

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	028553	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	:	1952526642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBURY FAMILY DENTAL

Provider Business Mailing Address
First Line	:	118 RIVER RD
Second Line	:	SUITE # 14
City	:	HARRIMAN
State	:	NY
Zip	:	10926-3021
Country	:	US
Telephone Number	:	845-782-1800
Fax Number	:	845-782-3116

Provider Business Practice Location Address
First Line	:	118 RIVER ROAD
Second Line	:	SUITE # 14
City	:	HARRIMAN
State	:	NY
Zip	:	10926-3021
Country	:	US
Telephone Number	:	845-782-1800
Fax Number	:	845-782-3116

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD FRANK COHEN
Credential	:	DMD
Telephone Number	:	845-782-1800

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	06/25/2008

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1083303952 — ALBAN BRAMBLE
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Directions to “WOODBURY FAMILY DENTAL ” Practice Location

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