MEDICARE: PUGSLEY DENTAL P.C.

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	045703	NY

General Provider Information

NPI Number	:	1063685394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUGSLEY DENTAL P.C.

Provider Business Mailing Address
First Line	:	1211B PUGSLEY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-5040
Country	:	US
Telephone Number	:	718-794-0384
Fax Number	:	718-794-0789

Provider Business Practice Location Address
First Line	:	1211B PUGSLEY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-5040
Country	:	US
Telephone Number	:	718-794-0384
Fax Number	:	718-794-0789

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRITI PARIKH
Credential	:	DDS
Telephone Number	:	718-794-0384

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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