Provider Demographics
NPI:1376717678
Name:D&I DENTAL MANAGEMENT
Entity Type:Organization
Organization Name:D&I DENTAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALYTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-544-8900
Mailing Address - Street 1:41 KEW GARDENS RD STE 1G
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1165
Mailing Address - Country:US
Mailing Address - Phone:718-544-8900
Mailing Address - Fax:718-544-0471
Practice Address - Street 1:41 KEW GARDENS RD STE 1G
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1165
Practice Address - Country:US
Practice Address - Phone:718-544-8900
Practice Address - Fax:718-544-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01205687Medicaid