MEDICARE: AARON'S 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	050804	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	:	1013235068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AARON'S DENTAL CARE

Provider Business Mailing Address
First Line	:	2474 8TH AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7710
Country	:	US
Telephone Number	:	212-234-6088
Fax Number	:	212-234-6088

Provider Business Practice Location Address
First Line	:	2474 8TH AVE STE A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7710
Country	:	US
Telephone Number	:	212-234-6088
Fax Number	:	212-234-6088

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AARON JAMES WICKS
Credential	:	DDS
Telephone Number	:	212-234-6088

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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Directions to “AARON'S DENTAL CARE ” Practice Location

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