Organization · NPI-2

1 Davison Ave Dentistry PLLC

Dentist, General Practice · Oceanside, NY

NPI number1063386555
StatusActive
Last updated in NPPESOct 9, 2025

Details

NPI
1063386555
Entity type
Organization (NPI-2)
Legal business name
1 Davison Ave Dentistry PLLC
Organization subpart
No
Enumeration date
Sep 30, 2025
Certification date
Oct 9, 2025
Last updated
Oct 9, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes

Other names

  • Elident (Doing Business As)

Practice location

1 Davison Ave W
Oceanside, NY 11572-2114

Phone 646-593-9305

Mailing address

1 Davison Ave W
Oceanside, NY 11572-2114

Authorized official

Gavriel Gulamov
Owner
6465939305

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