Provider Demographics
NPI:1013132554
Name:VERED MASLAVI, DDS, PC
Entity type:Organization
Organization Name:VERED MASLAVI, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VERED
Authorized Official - Middle Name:
Authorized Official - Last Name:MASLAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-279-0900
Mailing Address - Street 1:4505 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3042
Mailing Address - Country:US
Mailing Address - Phone:718-279-0900
Mailing Address - Fax:718-279-0929
Practice Address - Street 1:4505 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3042
Practice Address - Country:US
Practice Address - Phone:718-279-0900
Practice Address - Fax:718-279-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524963OtherMEDICAID ID NUMBER
NY9176784OtherDORAL ID NUMBER