Provider Demographics
NPI:1245691351
Name:EFFENDI, ZIYAD
Entity type:Individual
Prefix:
First Name:ZIYAD
Middle Name:
Last Name:EFFENDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 HINTON WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5911
Mailing Address - Country:US
Mailing Address - Phone:919-727-9363
Mailing Address - Fax:
Practice Address - Street 1:55 GREENE AVE STE LLA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6432
Practice Address - Country:US
Practice Address - Phone:718-230-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34507122300000X
NY0615551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist