MEDICARE: PETER MANN DDS

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	122300000X	Dentist	054580	NY

General Provider Information

NPI Number	:	1407189707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MANN DDS

Provider Business Mailing Address
First Line	:	2741 E 28TH ST APT 5G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2433
Country	:	US
Telephone Number	:	347-962-5301
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 E 28TH ST APT 5G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2433
Country	:	US
Telephone Number	:	347-962-5301
Fax Number	:

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

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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Directions to “ PETER MANN DDS” Practice Location

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