Yl Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047627 Issued in NY

Legal business name

YL DENTAL PC

Practice address

3030 Ocean Ave
Suite Aa
Brooklyn, NY 11235-3363

Phone

(718) 769-5379

Fax

(718) 769-2365

NPI assigned

Jul 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Edouard Etlis, DDSNPI 1013937416

Title

President

Phone

(718) 769-5379

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edouard Etlis, DDS

  • General Practice Dentistry
  • Brooklyn, NY
  • NPI 1013937416
  NPD (past) Authorized official
• Yanina Etlis, D.O.

  • Family Medicine Physician
  • Rego Park, NY
  • NPI 1730160920
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730109133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 OCEAN AVE",
            "address_2": "SUITE AA",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353363",
            "telephone_number": "718-769-5379",
            "fax_number": "718-769-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 OCEAN AVE",
            "address_2": "SUITE AA",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353363",
            "telephone_number": "718-769-5379",
            "fax_number": "718-769-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YL DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ETLIS",
        "authorized_official_first_name": "EDOUARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-769-5379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01855843",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ymga Pharmacy Services, Corp (Best Care Pharmacy)
• Yn Consulting

• General Practice Dentistry in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.