MEDICARE: DR. JOSHUA GINDEA D.D.S.

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	038176	NY

General Provider Information

NPI Number	:	1043585656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA GINDEA D.D.S.

Provider Business Mailing Address
First Line	:	1569 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3127
Country	:	US
Telephone Number	:	718-251-7167
Fax Number	:	718-251-7198

Provider Business Practice Location Address
First Line	:	1569 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3127
Country	:	US
Telephone Number	:	718-251-7167
Fax Number	:	718-251-7198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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