MEDICARE: NADER DAYANI 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	042807	NY

General Provider Information

NPI Number	:	1235397464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADER DAYANI D.D.S.

Provider Business Mailing Address
First Line	:	13703 171ST ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-4505
Country	:	US
Telephone Number	:	718-978-2120
Fax Number	:	718-978-2128

Provider Business Practice Location Address
First Line	:	13703 171ST ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11434-4505
Country	:	US
Telephone Number	:	718-978-2120
Fax Number	:	718-978-2128

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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