Provider Demographics
NPI:1598533903
Name:BAYSIDE LASER DENTAL PC
Entity Type:Organization
Organization Name:BAYSIDE LASER DENTAL PC
Other - Org Name:GREAT NECK LASER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYANG-RIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-279-8588
Mailing Address - Street 1:3651 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2169
Mailing Address - Country:US
Mailing Address - Phone:718-279-8588
Mailing Address - Fax:
Practice Address - Street 1:3651 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2169
Practice Address - Country:US
Practice Address - Phone:718-279-8588
Practice Address - Fax:718-631-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty