MEDICARE: E-Z DENTAL CARE 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1770728248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E-Z DENTAL CARE P.C.

Provider Business Mailing Address
First Line	:	PO BOX 227
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-0227
Country	:	US
Telephone Number	:	718-737-6735
Fax Number	:	718-367-4244

Provider Business Practice Location Address
First Line	:	86 W 183RD ST
Second Line	:	DENTAL OFFICE
City	:	BRONX
State	:	NY
Zip	:	10453-1212
Country	:	US
Telephone Number	:	718-367-4222
Fax Number	:	718-367-4244

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIROSLAVA KAUTSIS
Credential	:	D.D.S.
Telephone Number	:	718-367-4222

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	03/09/2010

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Directions to “E-Z DENTAL CARE P.C. ” Practice Location

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