MEDICARE: ALEKSANDR DAYANAYEV 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	046953-1	NY

General Provider Information

NPI Number	:	1417029182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDR DAYANAYEV DDS

Provider Business Mailing Address
First Line	:	108 50 65 AVENUE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	718-897-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3234 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4006
Country	:	US
Telephone Number	:	718-728-3314
Fax Number	:	718-932-4790

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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