Healthcare Provider Details

I. General information

NPI: 1376967158
Provider Name (Legal Business Name): ISAAC KUYUNOV D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 12/19/2021
Certification Date: 12/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WESTFALL RD STE A
ROCHESTER NY
14618-2635
US

IV. Provider business mailing address

900 WESTFALL RD STE A
ROCHESTER NY
14618-2635
US

V. Phone/Fax

Practice location:
  • Phone: 585-471-5689
  • Fax:
Mailing address:
  • Phone: 585-471-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number058033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: