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General NPI Number Information
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NPI Number | 1801667092
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Entity Type | Organization
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Legal Business Name | EASTERN LONG ISLAND DENTAL SERVICES
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 1452 DEER PARK AVENUE
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City | NORTH BABYLON
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State | NY
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Zip | 11703
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Country | US
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Telephone | 631-593-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 1452 DEER PARK AVENUE
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City | NORTH BABYLON
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State | NY
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Zip | 11703
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Country | US
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Telephone | 631-593-2211
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MR. SEFIK YAVUZ
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Credential | D.D.S
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Telephone | 516-287-7403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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