Provider Demographics
NPI:1487034609
Name:YELIZAR, TAMARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:YELIZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:ALISHAYEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8233 166TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1217
Mailing Address - Country:US
Mailing Address - Phone:917-496-1690
Mailing Address - Fax:
Practice Address - Street 1:400 S OYSTER BAY RD STE 105
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-336-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0585851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice