MEDICARE: TRIBECA DENTAL ASSOCIATE, 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	1223G0001X	General Practice Dentistry	048739	NY
2	1223P0300X	Periodontics	047254	NY
3	1223P0300X	Periodontics	0472584	NY

General Provider Information

NPI Number	:	1962513986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBECA DENTAL ASSOCIATE, PC

Provider Business Mailing Address
First Line	:	21 MURRAY STREET
Second Line	:	FLOOR 4
City	:	NEW YORK
State	:	NY
Zip	:	10007
Country	:	US
Telephone Number	:	212-346-0893
Fax Number	:	212-346-0894

Provider Business Practice Location Address
First Line	:	21 MURRAY ST
Second Line	:	FLOOR 4
City	:	NEW YORK
State	:	NY
Zip	:	10007-2239
Country	:	US
Telephone Number	:	212-346-0893
Fax Number	:	212-346-0894

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BAHRAM HAMIDI
Credential	:	DDS
Telephone Number	:	212-346-0893

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/04/2015

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