Healthcare Provider Details

I. General information

NPI: 1588755706
Provider Name (Legal Business Name): BEDROS YAVRU-SAKUK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92-29 QUEENS BOULEVARD STE # 1G
REGO PARK NY
11374
US

IV. Provider business mailing address

92-29 QUEENS BOULEVARD STE # 1G
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-5739
  • Fax: 718-896-5739
Mailing address:
  • Phone: 718-896-5739
  • Fax: 718-896-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: