MEDICARE: CAROL POVEDA 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	1223G0001X	General Practice Dentistry	046108	NY

General Provider Information

NPI Number	:	1154311090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL POVEDA DDS

Provider Business Mailing Address
First Line	:	902 COLUMBUS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4040
Country	:	US
Telephone Number	:	212-749-5000
Fax Number	:	212-749-5522

Provider Business Practice Location Address
First Line	:	902 COLUMBUS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4040
Country	:	US
Telephone Number	:	212-749-5000
Fax Number	:	212-749-5522

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

Provider Enumeration Date	:	10/23/2005
Last Update Date	:	07/08/2007

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Directions to “ CAROL POVEDA DDS” Practice Location

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