Healthcare Provider Details

I. General information

NPI: 1972194637
Provider Name (Legal Business Name): OSNAT KUYUNOV DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 68TH DR APT A12
FOREST HILLS NY
11375-3475
US

IV. Provider business mailing address

10421 68TH DR APT A12
FOREST HILLS NY
11375-3475
US

V. Phone/Fax

Practice location:
  • Phone: 718-785-6672
  • Fax:
Mailing address:
  • Phone: 718-785-6672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number061078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: