Provider Demographics
NPI:1679182919
Name:AVALON DENTAL, PC
Entity Type:Organization
Organization Name:AVALON DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-338-8652
Mailing Address - Street 1:20103 NORTHERN BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2563
Mailing Address - Country:US
Mailing Address - Phone:347-338-8652
Mailing Address - Fax:
Practice Address - Street 1:20103 NORTHERN BLVD FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11361-2563
Practice Address - Country:US
Practice Address - Phone:646-436-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental