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General NPI Number Information
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NPI Number | 1316835739
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Entity Type | Organization
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Legal Business Name | NY GENTLE DENTAL PC
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 820 MERRICK RD
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City | BALDWIN
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State | NY
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Zip | 11510-3354
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Country | US
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Telephone | 516-584-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 6213 CROMWELL CRES
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City | REGO PARK
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State | NY
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Zip | 11374-3937
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Country | US
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Telephone | 646-510-3787
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | ESTER FAZYLOVA
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Credential | DDS
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Telephone | 646-510-3787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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