MEDICARE: PATRICE DUNCAN RDH, B. 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	124Q00000X	Dental Hygienist	025152	NY

General Provider Information

NPI Number	:	1194268045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE DUNCAN RDH, B. S

Provider Business Mailing Address
First Line	:	1507 E 98TH ST
Second Line	:	FL 1
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5321
Country	:	US
Telephone Number	:	347-439-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	10170 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2081
Country	:	US
Telephone Number	:	718-441-7110
Fax Number	:

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

Provider Enumeration Date	:	11/27/2016
Last Update Date	:	11/29/2016

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