| Fourth Avenue Dental | |
|
5404 4th Ave Brooklyn NY 11220-3006 | |
| (718) 439-2876 | |
| (718) 439-2879 |
| Full Name | Fourth Avenue Dental |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 5404 4th Ave, Brooklyn, New York |
| Authorized Official Name and Position | Andrew Maron (DENTIST) |
| Authorized Official Contact | 7184392876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Avenue Dental 5404 4th Ave Brooklyn NY 11220-3006 Ph: (718) 439-2876 | Fourth Avenue Dental 5404 4th Ave Brooklyn NY 11220-3006 Ph: (718) 439-2876 |
| NPI Number | 1881993392 |
|---|---|
| Provider Enumeration Date | 03/23/2011 |
| Last Update Date | 08/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881993392 | NPI | - | NPPES |
| 03170656 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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