MEDICARE: KEW GARDENS 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	050268

General Provider Information

NPI Number	:	1780833434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEW GARDENS DENTAL P.C

Provider Business Mailing Address
First Line	:	8234 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2638
Country	:	US
Telephone Number	:	718-441-4442
Fax Number	:

Provider Business Practice Location Address
First Line	:	82-34 LEFFERTS BLVD
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2638
Country	:	US
Telephone Number	:	718-441-4442
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	BELLA PINKATZ
Credential	:	DDS
Telephone Number	:	718-441-4442

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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