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NPI Code Detail

MEDICARE: KENT STREET DENTAL

MEDICARE: KENT STREET DENTAL
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1487338000
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENT STREET DENTAL
Provider Business Mailing Address
First Line : 30 CENTRAL PARK S
Second Line :
City : NEW YORK
State : NY
Zip : 10019-1628
Country : US
Telephone Number : 917-915-4504
Fax Number :
Provider Business Practice Location Address
First Line : 169 KENT ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11222-2105
Country : US
Telephone Number : 212-287-5645
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DAVID JANSH
Credential : DMD
Telephone Number : 212-287-5645
Provider Enumeration Date : 06/14/2023
Last Update Date : 06/28/2023

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Directions to “KENT STREET DENTAL ” Practice Location

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