MEDICARE: DR. TATYANA YAPPORT DDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	045521-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235121203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA YAPPORT DDS

Provider Business Mailing Address
First Line	:	4701 QUEENS BLVD
Second Line	:	SUITE 202
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1600
Country	:	US
Telephone Number	:	718-706-1717
Fax Number	:	718-706-7477

Provider Business Practice Location Address
First Line	:	4701 QUEENS BLVD
Second Line	:	SUITE 202
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1600
Country	:	US
Telephone Number	:	718-706-1717
Fax Number	:	718-706-7477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/18/2014

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