Provider Demographics
NPI:1407967086
Name:ZLATA BAVLI DDS PC
Entity Type:Organization
Organization Name:ZLATA BAVLI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZLATA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAVLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-436-0100
Mailing Address - Street 1:1000 SOUTH ELMORA AVE
Mailing Address - Street 2:SUITE 1E ZHATA BAVLI DDS PC
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-436-0100
Mailing Address - Fax:908-436-0295
Practice Address - Street 1:1000 SOUTH ELMORA AVE
Practice Address - Street 2:Z BAVLI DDS PC
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202
Practice Address - Country:US
Practice Address - Phone:908-436-0100
Practice Address - Fax:908-436-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7277601Medicaid