Basic Information
| Provider Information | |||||||||
| NPI: | 1306446554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUZAYLOV | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ELLIOT ZVI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6504 ELLWELL CRES | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113745032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465750958 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6504 ELLWELL CRES | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113745032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465750958 | ||||||||
| FaxNumber: | 7186303244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 062400 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.