MEDICARE: DECENT DENTAL SERVICES, 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	038066	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871707968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECENT DENTAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	5801 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3819
Country	:	US
Telephone Number	:	718-492-0086
Fax Number	:	718-569-9055

Provider Business Practice Location Address
First Line	:	5801 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3819
Country	:	US
Telephone Number	:	718-492-0086
Fax Number	:	718-569-9055

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAYENDRA AMBALAL PANCHAL
Credential	:	DDS
Telephone Number	:	718-492-9211

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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