Individual
EDOUARD ETLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
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
07/08/2007
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