MEDICARE: ST. MARKS PAINLESS DENTAL

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	046200	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	:	1912997727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARKS PAINLESS DENTAL

Provider Business Mailing Address
First Line	:	907 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2004
Country	:	US
Telephone Number	:	718-778-3283
Fax Number	:	718-778-3284

Provider Business Practice Location Address
First Line	:	907 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-2004
Country	:	US
Telephone Number	:	718-778-3283
Fax Number	:	718-778-3284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VSEVOLOD UCHITELEV
Credential	:	DDS
Telephone Number	:	718-778-3283

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/22/2020

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