MEDICARE: CYPRESS HILLS DENTAL, 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	042827	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	:	1699954461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS HILLS DENTAL, PC

Provider Business Mailing Address
First Line	:	264 JAMAICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2105
Country	:	US
Telephone Number	:	718-827-2554
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 JAMAICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2105
Country	:	US
Telephone Number	:	718-827-2554
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MIRIAM BONET
Credential	:	DDS
Telephone Number	:	718-827-2554

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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