MEDICARE: ZEN DENTAL 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	122300000X	Dentist	053141	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306112560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEN DENTAL P.C.

Provider Business Mailing Address
First Line	:	563 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4655
Country	:	US
Telephone Number	:	845-527-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	563 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4655
Country	:	US
Telephone Number	:	845-527-7772
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TRISTAN L LUE
Credential	:	DDS
Telephone Number	:	845-527-7772

Provider Enumeration Date	:	03/31/2012
Last Update Date	:	03/31/2012

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Directions to “ZEN DENTAL P.C. ” Practice Location

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