Provider Demographics
NPI:1558558890
Name:AYVAZIAN, ELPHIDA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELPHIDA
Middle Name:G
Last Name:AYVAZIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BOND ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2025
Mailing Address - Country:US
Mailing Address - Phone:516-482-5416
Mailing Address - Fax:
Practice Address - Street 1:23 BOND ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2025
Practice Address - Country:US
Practice Address - Phone:516-482-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049889-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics