MEDICARE: CUTE PEARLS DENTAL CARE 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	305R00000X	Preferred Provider Organization	055155	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	:	1902228158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTE PEARLS DENTAL CARE PC

Provider Business Mailing Address
First Line	:	1749 GRAND CONCOURSE
Second Line	:	SUITE 1E
City	:	BRONX
State	:	NY
Zip	:	10453-8241
Country	:	US
Telephone Number	:	718-466-2222
Fax Number	:	718-466-6555

Provider Business Practice Location Address
First Line	:	1749 GRAND CONCOURSE
Second Line	:	SUITE 1E
City	:	BRONX
State	:	NY
Zip	:	10453-8241
Country	:	US
Telephone Number	:	718-466-2222
Fax Number	:	718-466-6555

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VICTOR ALEXEY ROBINSON
Credential	:	DDS
Telephone Number	:	516-312-7690

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	01/07/2014

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