Provider Demographics
NPI:1336686526
Name:EUGENE AVRASH DDS, KATHY BOADWAY DDS, PLLC
Entity Type:Organization
Organization Name:EUGENE AVRASH DDS, KATHY BOADWAY DDS, PLLC
Other - Org Name:COLD SPRING DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-921-7444
Mailing Address - Street 1:99 COLD SPRING RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3140
Mailing Address - Country:US
Mailing Address - Phone:516-921-7444
Mailing Address - Fax:516-921-7287
Practice Address - Street 1:99 COLD SPRING RD STE 1
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3140
Practice Address - Country:US
Practice Address - Phone:516-921-7444
Practice Address - Fax:516-921-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty