Provider Demographics
NPI:1477638641
Name:EZZAT, HAYAT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYAT
Middle Name:M
Last Name:EZZAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2704
Mailing Address - Country:US
Mailing Address - Phone:718-728-7200
Mailing Address - Fax:718-728-8688
Practice Address - Street 1:2702 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11105-2704
Practice Address - Country:US
Practice Address - Phone:718-728-7200
Practice Address - Fax:718-728-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0379961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00835709Medicaid