MEDICARE: PEDIATRIC DENTAL ASSOCIATES, PC

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	1223P0221X	Pediatric Dentistry	047862	NY

General Provider Information

NPI Number	:	1225201460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	2132 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1406
Country	:	US
Telephone Number	:	718-645-1588
Fax Number	:	718-376-2381

Provider Business Practice Location Address
First Line	:	2132 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1406
Country	:	US
Telephone Number	:	718-645-1588
Fax Number	:	718-376-2381

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ELAN KAUFMAN
Credential	:	DMD
Telephone Number	:	718-645-1588

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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