MEDICARE: TEETH TAMERS DENTAL CARE, 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	48848	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699946277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEETH TAMERS DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	25 BURNS ST
Second Line	:	STE 1C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	718-261-4747
Fax Number	:	718-261-4945

Provider Business Practice Location Address
First Line	:	25 BURNS ST
Second Line	:	STE 1C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	718-261-4747
Fax Number	:	718-261-4945

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLEG VINSON
Credential	:	DDS
Telephone Number	:	718-261-4747

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/21/2008

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