MEDICARE: DR. EUGENE KENIGSBERG 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	1223G0001X	General Practice Dentistry	054004	NY

General Provider Information

NPI Number	:	1073760468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE KENIGSBERG D.D.S.

Provider Business Mailing Address
First Line	:	1804 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-253-2000
Fax Number	:	718-253-2089

Provider Business Practice Location Address
First Line	:	1804 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-253-2000
Fax Number	:	718-253-2089

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	07/05/2012

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