MEDICARE: COOL DENTIST PLLC

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

General Provider Information

NPI Number	:	1023662137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOL DENTIST PLLC

Provider Business Mailing Address
First Line	:	205 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1311
Country	:	US
Telephone Number	:	718-727-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1311
Country	:	US
Telephone Number	:	718-727-2555
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DR. GEET CHAINANI
Credential	:
Telephone Number	:	718-727-2555

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	07/26/2019

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Directions to “COOL DENTIST PLLC ” Practice Location

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