Individual
EYRA IXCOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2000 GRAND AVE, NORTH BALDWIN, NY 11510-2811
(516) 378-1968
(516) 608-9319
Mailing address
2000 GRAND AVE, NORTH BALDWIN, NY 11510-2811
(516) 378-1968
(516) 608-9319
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
P82633
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P82633
TEMPORARY PERMIT AWAITING TO TAKE THE TEST FOR LICENSURE
NY
Enumeration date
03/29/2012
Last updated
03/29/2012
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