Provider Demographics
NPI:1881973758
Name:SCHWARTZ, EVELYN L (DMD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BACON RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1304
Mailing Address - Country:US
Mailing Address - Phone:516-721-2961
Mailing Address - Fax:
Practice Address - Street 1:129 BACON RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1304
Practice Address - Country:US
Practice Address - Phone:516-721-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist