MEDICARE: BLUESTAR 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	049803-1	NY
2	1223P0700X	Prosthodontics	047926-1	NY
3	122300000X	Dentist	049832-1	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	:	1720156870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUESTAR DENTAL CARE

Provider Business Mailing Address
First Line	:	2110 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5802
Country	:	US
Telephone Number	:	718-209-8500
Fax Number	:	718-942-4582

Provider Business Practice Location Address
First Line	:	2110 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5802
Country	:	US
Telephone Number	:	718-209-8500
Fax Number	:	718-942-4582

Authorized Official
Title or Position	:	DIRECTOR OF DENTAL AND ORAL MED
Name	:	DR. MICHAEL R DAGOSTINO
Credential	:	DDS
Telephone Number	:	718-209-8500

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	03/20/2008

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Directions to “BLUESTAR DENTAL CARE ” Practice Location

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