MEDICARE: ESTER FAZYLOVA DDS

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	061104	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356909469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTER FAZYLOVA DDS

Provider Business Mailing Address
First Line	:	6155 98TH ST APT 9M
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-1438
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/22/2025

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Directions to “ ESTER FAZYLOVA DDS” Practice Location

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