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General NPI Number Information
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NPI Number | 1720807340
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Entity Type | Organization
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Legal Business Name | AY DENTAL SERVICE
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 26404 UNION TPKE
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City | FLORAL PARK
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State | NY
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Zip | 11004-1334
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Country | US
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Telephone | 718-343-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 6837 YELLOWSTONE BLVD APT C67
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City | FOREST HILLS
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State | NY
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Zip | 11375-3408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AVI YADGAROV
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Credential | DDS
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Telephone | 347-387-2395
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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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