Healthcare Provider Details

I. General information

NPI: 1801887146
Provider Name (Legal Business Name): AISEL L FELIX D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320A ROOSEVELT AVE
JACKSON HTS NY
11372-7944
US

IV. Provider business mailing address

12 HARTWELL PL
WOODMERE NY
11598-1222
US

V. Phone/Fax

Practice location:
  • Phone: 718-396-6009
  • Fax:
Mailing address:
  • Phone: 917-292-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0476681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: