MEDICARE: GLENWOOD DENTAL CARE PLLC

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

General Provider Information

NPI Number	:	1740639574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENWOOD DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	1569 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3127
Country	:	US
Telephone Number	:	718-251-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	1569 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3127
Country	:	US
Telephone Number	:	718-251-7167
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DAVID CHO
Credential	:	DDS
Telephone Number	:	917-670-5238

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/14/2016

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