MEDICARE: J. GHARDA DENTAL P.L.L.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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114490067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. GHARDA DENTAL P.L.L.C.

Provider Business Mailing Address
First Line	:	2614 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5010
Country	:	US
Telephone Number	:	718-743-6680
Fax Number	:	718-743-0729

Provider Business Practice Location Address
First Line	:	2614 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5010
Country	:	US
Telephone Number	:	718-743-6680
Fax Number	:	718-743-0729

Authorized Official
Title or Position	:	CEO
Name	:	JAMSHED GHARDA
Credential	:	DMD
Telephone Number	:	718-743-6680

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	08/15/2019

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