Provider Demographics
NPI:1790161677
Name:ELYASI, ARVIN (DDS)
Entity Type:Individual
Prefix:
First Name:ARVIN
Middle Name:
Last Name:ELYASI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1667
Mailing Address - Country:US
Mailing Address - Phone:516-660-6343
Mailing Address - Fax:
Practice Address - Street 1:65 WARWICK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1667
Practice Address - Country:US
Practice Address - Phone:516-660-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist