Provider Demographics
NPI:1972592012
Name:FERREIRA, EDDY A (DDS)
Entity type:Individual
Prefix:DR
First Name:EDDY
Middle Name:A
Last Name:FERREIRA
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 1:3564 79TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4817
Mailing Address - Country:US
Mailing Address - Phone:718-478-4242
Mailing Address - Fax:718-478-4475
Practice Address - Street 1:3564 79TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-4817
Practice Address - Country:US
Practice Address - Phone:718-478-4242
Practice Address - Fax:718-478-4475
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226140Medicaid
NY0008223OtherDORAL PROVIDER #