MEDICARE: M M DENTAL 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	122300000X	Dentist	044784	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	:	1003892381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M M DENTAL PC

Provider Business Mailing Address
First Line	:	50 SHORE BLVD
Second Line	:	LOBBY
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4057
Country	:	US
Telephone Number	:	718-769-9777
Fax Number	:	718-769-9777

Provider Business Practice Location Address
First Line	:	50 SHORE BLVD
Second Line	:	LOBBY
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4057
Country	:	US
Telephone Number	:	718-769-9777
Fax Number	:	718-769-9777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK MEYLER
Credential	:	DDS
Telephone Number	:	718-769-9777

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/22/2020

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Directions to “M M DENTAL PC ” Practice Location

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