MEDICARE: TREMONT SMILES DENTAL 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	1223G0001X	General Practice Dentistry	058687	NY

General Provider Information

NPI Number	:	1336652593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREMONT SMILES DENTAL PC

Provider Business Mailing Address
First Line	:	563 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4655
Country	:	US
Telephone Number	:	718-466-4500
Fax Number	:	917-792-8502

Provider Business Practice Location Address
First Line	:	563 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-4655
Country	:	US
Telephone Number	:	718-466-4500
Fax Number	:	917-792-8502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMARA MARSH
Credential	:	DDS
Telephone Number	:	718-466-4500

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/10/2017

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