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NPI Code Detail

MEDICARE: SURESH C MITTAL DDS

MEDICARE: SURESH C MITTAL 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
1122300000XDentist033444NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205821915
Entity Type Code : Individual
Provider Name (Legal Business Name) : SURESH C MITTAL DDS
Provider Business Mailing Address
First Line : 153 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3108
Country : US
Telephone Number : 718-783-1646
Fax Number : 718-783-1646
Provider Business Practice Location Address
First Line : 153 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-3108
Country : US
Telephone Number : 718-783-1646
Fax Number : 718-783-1646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 07/08/2007

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