MEDICARE: GLENDALE DENTAL ASSOCIATES

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	0528341	NY

General Provider Information

NPI Number	:	1033341532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	7407 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-386-2655
Fax Number	:

Provider Business Practice Location Address
First Line	:	7407 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7433
Country	:	US
Telephone Number	:	718-386-2655
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT P CUKIER
Credential	:	D.D.S.
Telephone Number	:	718-386-2655

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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