MEDICARE: MARGARITA DEGTYAREVA, DDS, PC

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

General Provider Information

NPI Number	:	1821362492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGARITA DEGTYAREVA, DDS, PC

Provider Business Mailing Address
First Line	:	1725 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3606
Country	:	US
Telephone Number	:	718-743-0299
Fax Number	:	718-743-1468

Provider Business Practice Location Address
First Line	:	1725 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3606
Country	:	US
Telephone Number	:	718-743-0299
Fax Number	:	718-743-1468

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARITA DEGTYAREVA
Credential	:	DDS
Telephone Number	:	718-743-0299

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	02/29/2012

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