Edouard Etlis Dental, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

047627 Issued in NY

Legal business name

EDOUARD ETLIS DENTAL, P.C.

Practice address

9516 Church Ave
Brooklyn, NY 11212-2434

Phone

(718) 495-8801

NPI assigned

Apr 7, 2016

Organization subpart

No

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

Authorized official

Name

Edouard Etlis, DDS

Title

President

Phone

(646) 512-2777

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1952765828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 FOCH AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103054438",
            "fax_number": "718-495-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9516 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112122434",
            "telephone_number": "718-495-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDOUARD ETLIS DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-07",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "ETLIS",
        "authorized_official_first_name": "EDOUARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "646-512-2777",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yotonda Edmund, M.S.,CF-SLP
• Adrianne Edmunds
• Mandy Edmunds
• Edna Anne Pytlak, MD & Brianne O'Connor, MD, LLP
• Christina Edano Ednalino, M.D.
• Claude Rafael Edouard, MD
• Francoise Edouard
• Guy Robert Edouard, LMHC
• Kathleen A Edouard, MD
• Louis Edouard

• 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 Apr 7, 2016; 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.