MEDICARE: DR. VALENTINA MERCEDES SASIETA D.D.S.

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	50057563	NY

General Provider Information

NPI Number	:	1386083376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALENTINA MERCEDES SASIETA D.D.S.

Provider Business Mailing Address
First Line	:	655 2ND AVE
Second Line	:	APT 5C
City	:	NEW YORK
State	:	NY
Zip	:	10016-4269
Country	:	US
Telephone Number	:	917-969-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 JAMAICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2105
Country	:	US
Telephone Number	:	718-827-2554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2013
Last Update Date	:	12/11/2014

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