Provider Demographics
NPI:1629265053
Name:VERED MASLAVI, DDS, PC
Entity Type:Organization
Organization Name:VERED MASLAVI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERED
Authorized Official - Middle Name:
Authorized Official - Last Name:MASLAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-279-0900
Mailing Address - Street 1:2220 WISTERIA DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2656
Mailing Address - Country:US
Mailing Address - Phone:678-252-2137
Mailing Address - Fax:678-336-7099
Practice Address - Street 1:4505 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3042
Practice Address - Country:US
Practice Address - Phone:718-279-0900
Practice Address - Fax:718-279-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY49740261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental