MEDICARE: YELLOW BEAR PEDIATRIC DENTISTRY, 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	1223P0221X	Pediatric Dentistry	056718	NY

General Provider Information

NPI Number	:	1770946931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELLOW BEAR PEDIATRIC DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	1471 DEKALB AVE
Second Line	:	FL 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 KNICKERBOCKER AVE
Second Line	:	SUITE 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3601
Country	:	US
Telephone Number	:	717-201-8047
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAI DO
Credential	:	D.D.S.
Telephone Number	:	717-201-8047

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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