MEDICARE: DENTAL OFFICE

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	044215	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	:	1710345087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL OFFICE

Provider Business Mailing Address
First Line	:	1810 JEROME AVE FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3621
Country	:	US
Telephone Number	:	718-646-0900
Fax Number	:	718-769-9723

Provider Business Practice Location Address
First Line	:	1810 JEROME AVE FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3621
Country	:	US
Telephone Number	:	718-646-0900
Fax Number	:	718-769-9723

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. YEVGENY AVDEYCHIK
Credential	:	DDS
Telephone Number	:	718-646-0900

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

Similar Medicare Providers

1134100936 — MRS. TATYANA AVDEYCHIK DDS
Practice Location Address:

1810 JEROME AVE FL 1
BROOKLYN, NY
11235-3621

Practice Phone: 718-646-0900
Practice Fax: 718-769-9723

1689655482 — MR. YEVGENY AVDEYCHIK DDS
Practice Location Address:

1810 JEROME AVE , 1 FLOOR
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1821100611 — MS. IRINA MINKOVA DDS
Practice Location Address:

1810 JEROME AVE FL 2
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1487797338 — JEROME DENTAL PC
Practice Location Address:

1810 JEROME AVE , 2ND FLOOR
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Practice Fax: 718-615-2030

1528286150 — MJ-MC HOME HEALTH CARE AGENCY,INC
Practice Location Address:

1810 JEROME AVE. , 1ST . FL.
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1265632798 — DR. NATALIYA GUBENKO DDS
Practice Location Address:

1810 JEROME AVE , 2 ND FLOOR
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Practice Phone: 718-615-2030
Practice Fax: 718-615-2030

Directions to “DENTAL OFFICE ” Practice Location

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