MEDICARE: DR. EHUD SASSON 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	122300000X	Dentist	056079	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	:	1154615854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EHUD SASSON D.D.S.

Provider Business Mailing Address
First Line	:	1761 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4825
Country	:	US
Telephone Number	:	718-531-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9323 AVENUE L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4806
Country	:	US
Telephone Number	:	718-763-0505
Fax Number	:	718-763-1776

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	10/12/2018

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