MEDICARE: DENTAL IMPLANT AND COSMETIC, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1659649424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL IMPLANT AND COSMETIC, PC

Provider Business Mailing Address
First Line	:	2004 CROMPOND RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4231
Country	:	US
Telephone Number	:	914-243-7777
Fax Number	:	914-243-6236

Provider Business Practice Location Address
First Line	:	2004 CROMPOND RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4231
Country	:	US
Telephone Number	:	914-243-7777
Fax Number	:	914-243-6236

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH ZAKY
Credential	:
Telephone Number	:	914-243-7777

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	12/08/2011

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