MEDICARE: PEDIATRIC DENTAL AND ASSOCIATES OF BROOKLYN 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	1223P0221X	Pediatric Dentistry	047701	NY

General Provider Information

NPI Number	:	1568822732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL AND ASSOCIATES OF BROOKLYN PC

Provider Business Mailing Address
First Line	:	2464 CONEY ISLAND AVENUE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223
Country	:	US
Telephone Number	:	718-998-2424
Fax Number	:	718-998-9042

Provider Business Practice Location Address
First Line	:	2464 CONEY ISLAND AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5022
Country	:	US
Telephone Number	:	718-998-2424
Fax Number	:	718-998-9042

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YURY SLEPAK
Credential	:	D.D.S
Telephone Number	:	718-998-2424

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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