MEDICARE: CUTE DENTAL CARE

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	046388	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700924362	OTHER	NY	TYPE 1 NPI

General Provider Information

NPI Number	:	1689858565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTE DENTAL CARE

Provider Business Mailing Address
First Line	:	16701 HILLSIDE AVE
Second Line	:	2ND FL.
City	:	JAMAICA
State	:	NY
Zip	:	11432-4289
Country	:	US
Telephone Number	:	718-526-5999
Fax Number	:	718-466-6555

Provider Business Practice Location Address
First Line	:	1749 GRAND CONCOURSE
Second Line	:	GROUND FL
City	:	BRONX
State	:	NY
Zip	:	10453
Country	:	US
Telephone Number	:	718-466-2222
Fax Number	:	718-466-6555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMAD WAHEDUR RAHMAN
Credential	:	DDS
Telephone Number	:	718-466-2222

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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Directions to “CUTE DENTAL CARE ” Practice Location

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