Provider Demographics
NPI:1033443270
Name:EZ DENTAL SERVICE, PLLC
Entity Type:Organization
Organization Name:EZ DENTAL SERVICE, PLLC
Other - Org Name:EZ DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHUO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:857-998-9178
Mailing Address - Street 1:154-02 33RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-510-2122
Mailing Address - Fax:
Practice Address - Street 1:132-61 41ST ROAD
Practice Address - Street 2:UNIT #1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-510-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0541171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03167833Medicaid