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General NPI Number Information
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NPI Number | 1215135074
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Entity Type | Individual
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Provider Name | IRENE KAKOSYAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 405 LEXINGTON AVE FLOOR 21
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City | NEW YORK
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State | NY
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Zip | 10174-0002
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Country | US
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Telephone | 212-661-9777
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Fax | 212-661-9779
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Provider Business Mailing Address
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Address Line | 163 RIDGEWOOD AVE
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City | GLEN RIDGE
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State | NJ
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Zip | 07028-1104
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Country | US
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Telephone | 212-661-9777
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Fax | 212-661-9779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 049136-1
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License Number State | NY
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