MEDICARE: DR. MAUREEN A. ARCHER-FESTA 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	40213-1	NY

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	:	1154474161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN A. ARCHER-FESTA D.D.S.

Provider Business Mailing Address
First Line	:	34 NASSAU DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2158
Country	:	US
Telephone Number	:	516-829-8965
Fax Number	:	516-498-9364

Provider Business Practice Location Address
First Line	:	3755 76TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6507
Country	:	US
Telephone Number	:	718-429-6116
Fax Number	:	718-429-0843

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

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/09/2007

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