MEDICARE: COMMUNITY DENTAL ASSOCIATES 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	122300000X	Dentist	026694	NY

General Provider Information

NPI Number	:	1417027756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	133 E 54TH ST
Second Line	:	SUITE 2C
City	:	NEW YORK
State	:	NY
Zip	:	10022-4538
Country	:	US
Telephone Number	:	212-755-1637
Fax Number	:	212-371-0557

Provider Business Practice Location Address
First Line	:	133 E 54TH ST
Second Line	:	SUITE 2C
City	:	NEW YORK
State	:	NY
Zip	:	10022-4538
Country	:	US
Telephone Number	:	212-755-1637
Fax Number	:	212-371-0557

Authorized Official
Title or Position	:	PROSTHODONTIST
Name	:	DR. EDWARD A WOODS
Credential	:	DDS FAAHD
Telephone Number	:	212-755-1637

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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