MEDICARE: CARROLL GARDENS DENTAL ASSOCIATES, P.C.

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	050696	NY

General Provider Information

NPI Number	:	1750553731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLL GARDENS DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1040 1ST AVE
Second Line	:	#393
City	:	NEW YORK
State	:	NY
Zip	:	10022-2991
Country	:	US
Telephone Number	:	718-834-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4206
Country	:	US
Telephone Number	:	718-834-1446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD A ROSEN
Credential	:	D.D.S.
Telephone Number	:	718-834-1446

Provider Enumeration Date	:	03/30/2008
Last Update Date	:	03/30/2008

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