MEDICARE: LALABA 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588983738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LALABA DENTAL PC

Provider Business Mailing Address
First Line	:	2 WOODLAND CT
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1432
Country	:	US
Telephone Number	:	516-365-3701
Fax Number	:	516-365-3701

Provider Business Practice Location Address
First Line	:	679 E 138TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-3307
Country	:	US
Telephone Number	:	718-665-6065
Fax Number	:	718-665-6065

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MITA SHARAD PATEL
Credential	:	D.D.S
Telephone Number	:	516-365-3701

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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Directions to “LALABA DENTAL PC ” Practice Location

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