Provider Demographics
NPI:1043790462
Name:ISAAK YELIZAR DDS PLLC
Entity Type:Organization
Organization Name:ISAAK YELIZAR DDS PLLC
Other - Org Name:SIMPLIBRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAK
Authorized Official - Middle Name:
Authorized Official - Last Name:YELIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-674-7225
Mailing Address - Street 1:63109 SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63109 SAUNDERS ST STE BA2
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3100
Practice Address - Country:US
Practice Address - Phone:347-674-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0557321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty