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NPI Code Detail

MEDICARE: UNIVERSAL DENTAL ARTS, PC

MEDICARE: UNIVERSAL DENTAL ARTS, 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
11223G0001XGeneral Practice Dentistry042827NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598953655
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSAL DENTAL ARTS, PC
Provider Business Mailing Address
First Line : 169 WYCKOFF AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11237-4303
Country : US
Telephone Number : 646-393-5454
Fax Number :
Provider Business Practice Location Address
First Line : 169 WYCKOFF AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11237-4303
Country : US
Telephone Number : 646-393-5454
Fax Number :
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. MIRIAM BONET
Credential : DDS
Telephone Number : 646-393-5454
Provider Enumeration Date : 10/12/2007
Last Update Date : 10/12/2007

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