MEDICARE: SEPID DENTAL CARE 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	1223G0001X	General Practice Dentistry	053990	NY

General Provider Information

NPI Number	:	1326485343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEPID DENTAL CARE P.C.

Provider Business Mailing Address
First Line	:	8445 ABINGDON RD
Second Line	:	3RD FLOOR
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2101
Country	:	US
Telephone Number	:	917-291-2575
Fax Number	:

Provider Business Practice Location Address
First Line	:	11956 METROPOLITAN AVE
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2606
Country	:	US
Telephone Number	:	718-441-2291
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	MARYAM ARABZADEH KASHANI
Credential	:	D.D.S.
Telephone Number	:	917-291-2575

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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