Provider Demographics
NPI:1568693257
Name:DALLET, NATELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATELA
Middle Name:
Last Name:DALLET
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 1:9715 HORACE HARDING EXPY APT 14B
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4734
Mailing Address - Country:US
Mailing Address - Phone:917-604-0511
Mailing Address - Fax:
Practice Address - Street 1:7002 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5902
Practice Address - Country:US
Practice Address - Phone:718-417-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice