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NPI Code Detail

MEDICARE: BONANN GIFFORD GILL RDH

MEDICARE: BONANN GIFFORD GILL RDH
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
1124Q00000XDental Hygienist021860NY

General Provider Information

NPI Number : 1497827174
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONANN GIFFORD GILL RDH
Provider Business Mailing Address
First Line : 915 E 40TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-3509
Country : US
Telephone Number : 718-345-5000
Fax Number : 718-346-6747
Provider Business Practice Location Address
First Line : 592 ROCKAWAY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-5539
Country : US
Telephone Number : 718-345-5000
Fax Number : 718-346-6747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 07/08/2007

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Directions to “ BONANN GIFFORD GILL RDH” Practice Location

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