Healthcare Provider Details

I. General information

NPI: 1548195167
Provider Name (Legal Business Name): ANTON KIRYAKO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W GRAND AVE STE 100
MONTVALE NJ
07645-1829
US

IV. Provider business mailing address

687 KENNEDY DR
TWP WASHINGTN NJ
07676-4106
US

V. Phone/Fax

Practice location:
  • Phone: 201-746-9474
  • Fax:
Mailing address:
  • Phone: 201-407-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: