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Organization
YL DENTAL PC
Active
Organization
YL DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDOUARD ETLIS DDS (PRESIDENT)
(718) 769-5379
Entity
Organization
Contact information
Practice address
3030 OCEAN AVE, SUITE AA, BROOKLYN, NY 11235-3363
(718) 769-5379
(718) 769-2365
Mailing address
3030 OCEAN AVE, SUITE AA, BROOKLYN, NY 11235-3363
(718) 769-5379
(718) 769-2365
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
047627
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01855843
—
NY
Enumeration date
07/20/2006
Last updated
08/22/2020
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