MEDICARE: UTICA DENTAL STUDIO PLLC

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1578370680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTICA DENTAL STUDIO PLLC

Provider Business Mailing Address
First Line	:	1388 SAINT JOHNS PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3810
Country	:	US
Telephone Number	:	718-467-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 SAINT JOHNS PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3810
Country	:	US
Telephone Number	:	718-467-6336
Fax Number	:

Authorized Official
Title or Position	:	MEMBER OF LLC
Name	:	DR. YADVERINDER SINGH
Credential	:	DMD
Telephone Number	:	860-595-8388

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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