MEDICARE: VERVEDENT 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	047934-1	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	:	1407207459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERVEDENT DENTAL PC

Provider Business Mailing Address
First Line	:	13987 35TH AVE
Second Line	:	L2
City	:	FLUSHING
State	:	NY
Zip	:	11354-3548
Country	:	US
Telephone Number	:	718-961-0528
Fax Number	:	718-961-4538

Provider Business Practice Location Address
First Line	:	13987 35TH AVE
Second Line	:	L2
City	:	FLUSHING
State	:	NY
Zip	:	11354-3548
Country	:	US
Telephone Number	:	718-961-0528
Fax Number	:	718-961-4538

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANNY LO
Credential	:	DDS
Telephone Number	:	718-961-0528

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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Directions to “VERVEDENT DENTAL PC ” Practice Location

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