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NPI Code Detail

MEDICARE: EVGENI GORIOUNOV D.D.S.

MEDICARE:   EVGENI  GORIOUNOV  D.D.S.
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
11223G0001XGeneral Practice Dentistry22DI02094100NJ

General Provider Information

NPI Number : 1356342588
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVGENI GORIOUNOV D.D.S.
Provider Business Mailing Address
First Line : 6 CHAPEL HILL CT
Second Line :
City : CEDAR GROVE
State : NJ
Zip : 07009-1302
Country : US
Telephone Number : 917-921-8519
Fax Number :
Provider Business Practice Location Address
First Line : 139 MAIN AVE
Second Line :
City : CLIFTON
State : NJ
Zip : 07014-1707
Country : US
Telephone Number : 973-471-8300
Fax Number : 973-471-6662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 07/08/2007

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Directions to “ EVGENI GORIOUNOV D.D.S.” Practice Location

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