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General NPI Number Information
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NPI Number | 1215196944
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Entity Type | Organization
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Legal Business Name | ALEXANDER D. BORUKHOV, DMD, P.C.
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 10857 64TH AVE STE 1
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City | FOREST HILLS
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State | NY
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Zip | 11375-1442
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Country | US
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Telephone | 718-830-6263
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Fax |
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Provider Business Mailing Address
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Address Line | 10857 64TH AVE STE 1
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City | FOREST HILLS
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State | NY
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Zip | 11375-1442
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Country | US
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Telephone | 718-830-6263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER BORUKHOV
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Credential | D.M.D.
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Telephone | 718-830-6263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 048512
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License Number State | NY
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