MEDICARE: LITTLE TOOTH PEDIATRIC DENTISTRY 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679308167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE TOOTH PEDIATRIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	8059 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8059 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1735
Country	:	US
Telephone Number	:	347-454-9005
Fax Number	:	347-454-9015

Authorized Official
Title or Position	:	OWNER
Name	:	PAVEL ZEYLIKMAN
Credential	:	DMD
Telephone Number	:	917-326-0205

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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