MEDICARE: TATIANA KOROL, D.D.S., PLLC

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

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	:	1972791721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATIANA KOROL, D.D.S., PLLC

Provider Business Mailing Address
First Line	:	3049 OCEAN PKWY
Second Line	:	SUITE 301
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8302
Country	:	US
Telephone Number	:	718-333-1144
Fax Number	:	718-333-0695

Provider Business Practice Location Address
First Line	:	3049 OCEAN PKWY
Second Line	:	SUITE 301
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8302
Country	:	US
Telephone Number	:	718-333-1144
Fax Number	:	718-333-0695

Authorized Official
Title or Position	:	OWNER
Name	:	TATIANA KOROL
Credential	:	DDS
Telephone Number	:	718-333-1144

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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