MEDICARE: THE TOWNSEND DENTAL PRACTICE 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	122300000X	Dentist	048351	NY

General Provider Information

NPI Number	:	1770699878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TOWNSEND DENTAL PRACTICE P.C.

Provider Business Mailing Address
First Line	:	1606 TOWNSEND AVE
Second Line	:	PO BOX 846
City	:	BRONX
State	:	NY
Zip	:	10452-5944
Country	:	US
Telephone Number	:	718-299-1724
Fax Number	:	718-299-1723

Provider Business Practice Location Address
First Line	:	1606 TOWNSEND AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5944
Country	:	US
Telephone Number	:	718-299-1724
Fax Number	:	718-299-1723

Authorized Official
Title or Position	:	CEO
Name	:	DR. GUNANAND PERSAUD JR.
Credential	:	DDS
Telephone Number	:	718-299-1724

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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