Provider Demographics
NPI:1760727754
Name:D&L DENTAL PC
Entity Type:Organization
Organization Name:D&L DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-901-3821
Mailing Address - Street 1:21120 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2531
Mailing Address - Country:US
Mailing Address - Phone:347-901-3821
Mailing Address - Fax:
Practice Address - Street 1:92-11 35AVE APT 1K
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:347-901-3821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental