MEDICARE: ELITE DENTISTRY P.C.

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	052748	NY

General Provider Information

NPI Number	:	1689904138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE DENTISTRY P.C.

Provider Business Mailing Address
First Line	:	286 MADISON AVE
Second Line	:	SUITE 1000
City	:	NEW YORK
State	:	NY
Zip	:	10017-6345
Country	:	US
Telephone Number	:	212-221-0322
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 MADISON AVE
Second Line	:	SUITE 1000
City	:	NEW YORK
State	:	NY
Zip	:	10017-6345
Country	:	US
Telephone Number	:	212-221-0322
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LYNN ROBERTSON
Credential	:	D.M.D
Telephone Number	:	212-221-0322

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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