MEDICARE: DR. MARK KAUFMAN DDS

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	122300000X	Dentist	AK2992724	NY

General Provider Information

NPI Number	:	1629267448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK KAUFMAN DDS

Provider Business Mailing Address
First Line	:	1805 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3808
Country	:	US
Telephone Number	:	718-258-1931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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