MEDICARE: DC DENTAL OFFICE, P.C.

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	122300000X	Dentist	045810-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0016322	OTHER	NY	DORAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003088659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DC DENTAL OFFICE, P.C.

Provider Business Mailing Address
First Line	:	2925 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10468-1707
Country	:	US
Telephone Number	:	718-329-4111
Fax Number	:	718-329-1614

Provider Business Practice Location Address
First Line	:	2925 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10468-1707
Country	:	US
Telephone Number	:	718-329-4111
Fax Number	:	718-329-1614

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DAMARIS A CORDERO
Credential	:	D.D.S.
Telephone Number	:	718-329-4111

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	03/24/2008

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