MEDICARE: JA ADVANCE DENTISTRY, 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	1223P0300X	Periodontics	049516	NY

General Provider Information

NPI Number	:	1275806127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JA ADVANCE DENTISTRY, PC

Provider Business Mailing Address
First Line	:	6514 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1856
Country	:	US
Telephone Number	:	917-282-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	6514 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1856
Country	:	US
Telephone Number	:	917-282-9808
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOSEPH I ARONOFF
Credential	:	DDS, MS
Telephone Number	:	917-282-9808

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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