MEDICARE: IOSIF UVAYDOV D.D.S P.C.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255512711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOSIF UVAYDOV D.D.S P.C.

Provider Business Mailing Address
First Line	:	2101 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1509
Country	:	US
Telephone Number	:	718-951-2261
Fax Number	:	718-951-2018

Provider Business Practice Location Address
First Line	:	2101 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1509
Country	:	US
Telephone Number	:	718-951-2261
Fax Number	:	718-951-2018

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IOSIF UVAYDOV
Credential	:	DDS
Telephone Number	:	718-951-2261

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/26/2007

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