MEDICARE: DR. KATHLEEN M FROST DDS

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	1223P0300X	Periodontics	043727-0	NY

General Provider Information

NPI Number	:	1144240714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN M FROST DDS

Provider Business Mailing Address
First Line	:	150 ISLIP AVE
Second Line	:	SUITE 11
City	:	ISLIP
State	:	NY
Zip	:	11751-3222
Country	:	US
Telephone Number	:	631-581-3100
Fax Number	:	631-581-8164

Provider Business Practice Location Address
First Line	:	150 ISLIP AVE
Second Line	:	SUITE 11
City	:	ISLIP
State	:	NY
Zip	:	11751-3222
Country	:	US
Telephone Number	:	631-581-3100
Fax Number	:	631-581-8164

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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