Healthcare Provider Details

I. General information

NPI: 1497096168
Provider Name (Legal Business Name): ELEFTHERIOS S. GAVRIIL, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 24TH AVE 1ST FLOOR
ASTORIA NY
11102-2834
US

IV. Provider business mailing address

2306 24TH AVE 1ST FLOOR
ASTORIA NY
11102-2834
US

V. Phone/Fax

Practice location:
  • Phone: 718-440-3457
  • Fax: 718-440-3458
Mailing address:
  • Phone: 718-440-3457
  • Fax: 718-440-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number053186
License Number StateNY

VIII. Authorized Official

Name: ELEFTHERIOS S GAVRIIL
Title or Position: OWNER
Credential: D.D.S
Phone: 718-440-3457