Provider Demographics
NPI:1285982645
Name:EDGAR, ALEVTINA I (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEVTINA
Middle Name:I
Last Name:EDGAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEVTINA
Other - Middle Name:I
Other - Last Name:YADGAROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 NORTH CENTRAL AVE SUITE #3
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3859
Mailing Address - Country:US
Mailing Address - Phone:516-887-0020
Mailing Address - Fax:
Practice Address - Street 1:139 N CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3859
Practice Address - Country:US
Practice Address - Phone:516-887-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500561761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice