Healthcare Provider Details

I. General information

NPI: 1558982934
Provider Name (Legal Business Name): ALAINA DANIELLE ZAVLANOV D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALAINA DANIELLE EDELMUTH D.D.S.

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

9001 63RD AVE
REGO PARK NY
11374-2837
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2000
  • Fax:
Mailing address:
  • Phone: 773-656-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number062064
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number062064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: