MEDICARE: DR. GERARD S DIFUSCO D.M.D.

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	036059	NY

General Provider Information

NPI Number	:	1154440923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD S DIFUSCO D.M.D.

Provider Business Mailing Address
First Line	:	1110 CROSSPOINTE LN
Second Line	:	STE A
City	:	WEBSTER
State	:	NY
Zip	:	14580-2968
Country	:	US
Telephone Number	:	585-872-4400
Fax Number	:	585-872-3526

Provider Business Practice Location Address
First Line	:	1110 CROSSPOINTE LN
Second Line	:	STE A
City	:	WEBSTER
State	:	NY
Zip	:	14580-2968
Country	:	US
Telephone Number	:	585-872-4400
Fax Number	:	585-872-3526

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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