MEDICARE: DR. GUNANAND PERSAUD JR. 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	048351	NY

General Provider Information

NPI Number	:	1396740270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUNANAND PERSAUD JR. D.D.S.

Provider Business Mailing Address
First Line	:	1606 TOWNSEND AVE.,P.O. BOX 846
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452
Country	:	US
Telephone Number	:	718-299-1724
Fax Number	:	718-299-1723

Provider Business Practice Location Address
First Line	:	1606 TOWNSEND AVE.
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-0000
Country	:	US
Telephone Number	:	718-299-1724
Fax Number	:	718-299-1723

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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