MEDICARE: DR. IGOR TARLO DDS MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	050910	NY

General Provider Information

NPI Number	:	1265688691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGOR TARLO DDS MD

Provider Business Mailing Address
First Line	:	1951 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2439
Country	:	US
Telephone Number	:	347-702-6544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2439
Country	:	US
Telephone Number	:	347-702-6544
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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