MEDICARE: R.L. DENTAL SERVICES, 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	029218-1	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	:	1356461925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R.L. DENTAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	6410 VETERANS AVE
Second Line	:	SUITE 205
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-251-5551
Fax Number	:	718-251-4425

Provider Business Practice Location Address
First Line	:	6410 VETERANS AVE
Second Line	:	SUITE 205
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-251-5551
Fax Number	:	718-251-4425

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JEROME LICHT
Credential	:	D.D.S.
Telephone Number	:	718-251-5551

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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Directions to “R.L. DENTAL SERVICES, P.C. ” Practice Location

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