MEDICARE: INOR DENTAL 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	049300	NY

General Provider Information

NPI Number	:	1528130945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INOR DENTAL PC

Provider Business Mailing Address
First Line	:	99 LOCUST AVE
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-2615
Country	:	US
Telephone Number	:	914-737-2838
Fax Number	:	914-737-8465

Provider Business Practice Location Address
First Line	:	99 LOCUST AVE
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-2615
Country	:	US
Telephone Number	:	914-737-2838
Fax Number	:	914-737-8465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IFEOMA NWOKORIE
Credential	:	DDS
Telephone Number	:	914-737-2838

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/13/2015

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