MEDICARE: DESIDER KOHN DMD

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	122300000X	Dentist	038510	NY

General Provider Information

NPI Number	:	1871768168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIDER KOHN DMD

Provider Business Mailing Address
First Line	:	5118 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3638
Country	:	US
Telephone Number	:	718-436-2246
Fax Number	:	718-435-6855

Provider Business Practice Location Address
First Line	:	5118 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3638
Country	:	US
Telephone Number	:	718-436-2246
Fax Number	:	718-435-6855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	07/02/2016

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Directions to “ DESIDER KOHN DMD” Practice Location

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