Provider Demographics
NPI:1497096168
Name:ELEFTHERIOS S. GAVRIIL, DDS PC
Entity Type:Organization
Organization Name:ELEFTHERIOS S. GAVRIIL, DDS PC
Other - Org Name:EAST RIVER ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEFTHERIOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAVRIIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-440-3457
Mailing Address - Street 1:2306 24TH AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2834
Mailing Address - Country:US
Mailing Address - Phone:718-440-3457
Mailing Address - Fax:718-440-3458
Practice Address - Street 1:2306 24TH AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2834
Practice Address - Country:US
Practice Address - Phone:718-440-3457
Practice Address - Fax:718-440-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty