Healthcare Provider Details

I. General information

NPI: 1568693257
Provider Name (Legal Business Name): NATELA DALLET DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CENTRAL AVE STE 214
LAWRENCE NY
11559-8507
US

IV. Provider business mailing address

9809 65TH RD APT 2A
REGO PARK NY
11374-3501
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-6787
  • Fax:
Mailing address:
  • Phone: 917-604-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: