MEDICARE: ARCH DENTAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223P0700X	Prosthodontics
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1043503949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCH DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	3 WASHINGTON SQUARE VLG
Second Line	:	SUITE 1B/D
City	:	NEW YORK
State	:	NY
Zip	:	10012-1836
Country	:	US
Telephone Number	:	212-477-4330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WASHINGTON SQUARE VLG
Second Line	:	SUITE 1B/D
City	:	NEW YORK
State	:	NY
Zip	:	10012-1836
Country	:	US
Telephone Number	:	212-477-4330
Fax Number	:	212-674-2290

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	ANGELA BUTO
Credential	:
Telephone Number	:	516-683-1870

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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