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General NPI Number Information
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NPI Number | 1144474180
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Entity Type | Organization
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Legal Business Name | R & I DENTAL, PLLC
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 9302 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2308
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Country | US
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Telephone | 718-323-9999
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Fax | 718-323-1076
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Provider Business Mailing Address
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Address Line | 9302 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2308
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Country | US
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Telephone | 718-323-9999
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Fax | 718-323-1076
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT ILYAYEV
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Credential | D.D.S.
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Telephone | 718-323-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 050069
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License Number State | NY
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