Provider Demographics
NPI:1114062254
Name:ADVANCED HYLAN DENTAL,PC
Entity Type:Organization
Organization Name:ADVANCED HYLAN DENTAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-304-6110
Mailing Address - Street 1:2691 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4300
Mailing Address - Country:US
Mailing Address - Phone:718-987-3365
Mailing Address - Fax:718-668-0183
Practice Address - Street 1:2691 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4300
Practice Address - Country:US
Practice Address - Phone:718-987-3365
Practice Address - Fax:718-668-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty