Healthcare Provider Details

I. General information

NPI: 1598533903
Provider Name (Legal Business Name): BAYSIDE LASER DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 BELL BLVD
BAYSIDE NY
11361-2169
US

IV. Provider business mailing address

3651 BELL BLVD
BAYSIDE NY
11361-2169
US

V. Phone/Fax

Practice location:
  • Phone: 718-279-8588
  • Fax: 718-631-6784
Mailing address:
  • Phone: 718-279-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. HYANG-RIM LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-279-8588