MEDICARE: YOUR DENTAL HOUSE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223E0200X	Endodontics
3	1223P0300X	Periodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1205709458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR DENTAL HOUSE, P.C.

Provider Business Mailing Address
First Line	:	549 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1329
Country	:	US
Telephone Number	:	929-900-2197
Fax Number	:	929-900-2198

Provider Business Practice Location Address
First Line	:	549 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1329
Country	:	US
Telephone Number	:	929-900-2197
Fax Number	:	929-900-2198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BORIS KAYLAKOV
Credential	:	DDS
Telephone Number	:	929-900-2197

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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Directions to “YOUR DENTAL HOUSE, P.C. ” Practice Location

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