MEDICARE: DENTAL MATTERS 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	054180	NY

General Provider Information

NPI Number	:	1518259068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL MATTERS PC

Provider Business Mailing Address
First Line	:	475 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4511
Country	:	US
Telephone Number	:	301-275-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4511
Country	:	US
Telephone Number	:	301-275-2153
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MASHA NYAMUPFUKUDZA
Credential	:	DDS
Telephone Number	:	301-275-2153

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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