MEDICARE: INTERNED DENTAL SYSTEMS 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		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	:	1447367511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNED DENTAL SYSTEMS PC

Provider Business Mailing Address
First Line	:	1849 86TH STREET
Second Line	:	INTERMED DENTAL SYSTEMS PC
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-256-0800
Fax Number	:	718-621-6444

Provider Business Practice Location Address
First Line	:	1849 86TH STREET
Second Line	:	INTERMED DENTAL SYSTEMS PC
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-256-0800
Fax Number	:	718-621-6444

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	MR. ALEXANDER HEIFITE
Credential	:	DDS
Telephone Number	:	718-256-0800

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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