MEDICARE: DR. SPENCER SVETCOV 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	50 058680	NY

General Provider Information

NPI Number	:	1417315953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER SVETCOV DDS

Provider Business Mailing Address
First Line	:	41 WYNDHAM CLOSE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2100
Country	:	US
Telephone Number	:	914-437-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	20906 UNION TPKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-3238
Country	:	US
Telephone Number	:	718-479-9400
Fax Number	:

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

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/18/2017

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