MEDICARE: NY GENTLE 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1316835739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY GENTLE DENTAL PC

Provider Business Mailing Address
First Line	:	6213 CROMWELL CRES
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3937
Country	:	US
Telephone Number	:	646-510-3787
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 MERRICK RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3354
Country	:	US
Telephone Number	:	516-584-0100
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	ESTER FAZYLOVA
Credential	:	DDS
Telephone Number	:	646-510-3787

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/30/2025

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