=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437443280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YURIY MAY DMD, AIAOMT, ND
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2011
-----------------------------------------------------
Last Update Date | 06/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 BIRDSEYE RD STE 240
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-2242
-----------------------------------------------------
Fax | 860-474-3574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 BIRDSEYE RD STE 240
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-2242
-----------------------------------------------------
Fax | 860-474-3574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 10827
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------