Provider Demographics
NPI:1306446554
Name:FUZAYLOV, DANIEL ELLIOT ZVI (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELLIOT ZVI
Last Name:FUZAYLOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 ELLWELL CRES
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5032
Mailing Address - Country:US
Mailing Address - Phone:646-575-0958
Mailing Address - Fax:
Practice Address - Street 1:6504 ELLWELL CRES
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5032
Practice Address - Country:US
Practice Address - Phone:646-575-0958
Practice Address - Fax:718-630-3244
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0624001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice