Provider Demographics
NPI:1841588613
Name:EVYDENT DENTISTRY PC
Entity Type:Organization
Organization Name:EVYDENT DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGADAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-567-3368
Mailing Address - Street 1:29 COOPER ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3819
Mailing Address - Country:US
Mailing Address - Phone:212-567-3368
Mailing Address - Fax:212-567-1941
Practice Address - Street 1:29 COOPER ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3819
Practice Address - Country:US
Practice Address - Phone:212-567-3368
Practice Address - Fax:212-567-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02735000Medicaid