MEDICARE: ELGAR FAMILY DENTAL 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	261QD0000X	Dental Clinic/Center	052054	NY

General Provider Information

NPI Number	:	1932488749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELGAR FAMILY DENTAL P.C.

Provider Business Mailing Address
First Line	:	120 ELGAR PL UNIT B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5103
Country	:	US
Telephone Number	:	718-708-7171
Fax Number	:	718-708-7172

Provider Business Practice Location Address
First Line	:	120 ELGAR PL UNIT B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5103
Country	:	US
Telephone Number	:	718-708-7171
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. SHAHRIAR MOINAMINI
Credential	:	DDS
Telephone Number	:	718-708-7171

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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