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NPI Code Detail

MEDICARE: BOYNTON DENTAL,PC

MEDICARE: BOYNTON DENTAL,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
11223G0001XGeneral Practice Dentistry041973NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952573594
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOYNTON DENTAL,PC
Provider Business Mailing Address
First Line : 1537 WESTCHESTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10472-2908
Country : US
Telephone Number : 718-617-0624
Fax Number : 718-328-3887
Provider Business Practice Location Address
First Line : 1537 WESTCHESTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10472-2908
Country : US
Telephone Number : 718-617-0624
Fax Number : 718-328-3887
Authorized Official
Title or Position : PRESIDENT
Name : DR. SAMY FATOUH
Credential :
Telephone Number : 718-617-0624
Provider Enumeration Date : 03/24/2008
Last Update Date : 03/24/2008

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