MEDICARE: GRAND DENTAL, 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	046936	NY

General Provider Information

NPI Number	:	1760488589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND DENTAL, P. C.

Provider Business Mailing Address
First Line	:	2000 GRAND AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2811
Country	:	US
Telephone Number	:	516-771-5251
Fax Number	:	516-378-4543

Provider Business Practice Location Address
First Line	:	2000 GRAND AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2811
Country	:	US
Telephone Number	:	516-771-5251
Fax Number	:	516-378-4543

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LINDA PLAAG
Credential	:	D.D.S.
Telephone Number	:	516-771-5251

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

2000 GRAND AVE
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11510-2811

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1427047653 — DAVID M SCHEINER D.P.M.
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1649234873 — DR. WOO YUP KANG DC
Practice Location Address:

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NORTH BALDWIN, NY
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1508065038 — DR. JASON JAMES STARACE DDS
Practice Location Address:

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1205011905 — SCHEINER FAMILY PODIATRY
Practice Location Address:

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