MEDICARE: BOWERY DENTAL

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1245727064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWERY DENTAL

Provider Business Mailing Address
First Line	:	145 CANAL ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-5033
Country	:	US
Telephone Number	:	917-388-3678
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 CANAL ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-5033
Country	:	US
Telephone Number	:	917-388-3678
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	EDDIE CHAN
Credential	:
Telephone Number	:	917-388-3678

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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Directions to “BOWERY DENTAL ” Practice Location

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