Provider Demographics
NPI:1548806227
Name:AVEZOFF, DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:AVEZOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:AVEZOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DANIEL AVEZOFF
Mailing Address - Street 2:6145 98TH STREET 11G
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:646-400-8781
Mailing Address - Fax:
Practice Address - Street 1:11956 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2606
Practice Address - Country:US
Practice Address - Phone:718-441-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY061756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program