Provider Demographics
NPI:1801667092
Name:EASTERN LONG ISLAND DENTAL SERVICES
Entity type:Organization
Organization Name:EASTERN LONG ISLAND DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SEFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:YAVUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-287-7403
Mailing Address - Street 1:1452 DEER PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703
Mailing Address - Country:US
Mailing Address - Phone:631-593-2211
Mailing Address - Fax:
Practice Address - Street 1:1452 DEER PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-593-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty