MEDICARE: KENNETH MARC GEWANT D.M.D.

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	1223P0300X	Periodontics	036102	NY

General Provider Information

NPI Number	:	1992707152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MARC GEWANT D.M.D.

Provider Business Mailing Address
First Line	:	20 BUCKNELL DR
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1802
Country	:	US
Telephone Number	:	516-376-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 BUCKNELL DR
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1802
Country	:	US
Telephone Number	:	516-376-5442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/06/2014

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