Healthcare Provider Details

I. General information

NPI: 1992594907
Provider Name (Legal Business Name): DENTISTRY BY SHERRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 BELL BLVD
BAYSIDE NY
11361-2063
US

IV. Provider business mailing address

23 COUNTRY DR S
STATEN ISLAND NY
10314-6061
US

V. Phone/Fax

Practice location:
  • Phone: 347-308-6888
  • Fax:
Mailing address:
  • Phone: 347-308-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHERRY AVICZER
Title or Position: DENTIST
Credential: DDS
Phone: 347-308-6888