Provider Demographics
NPI:1992834212
Name:GAVRIIL, ELEFTHERIOS SPILIOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELEFTHERIOS
Middle Name:SPILIOS
Last Name:GAVRIIL
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 1:2306 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2834
Mailing Address - Country:US
Mailing Address - Phone:917-612-7908
Mailing Address - Fax:
Practice Address - Street 1:2306 24TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2834
Practice Address - Country:US
Practice Address - Phone:917-612-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery