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General NPI Number Information
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NPI Number | 1932866514
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Entity Type | Organization
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Legal Business Name | YAKOV FUZAYLOV DENTAL PC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 7835 B SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11364
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Country | US
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Telephone | 718-470-2320
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Fax | 718-470-2321
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Provider Business Mailing Address
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Address Line | 7835 B SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11364
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Country | US
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Telephone | 718-470-2320
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Fax | 718-470-2320
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Authorized Official
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Title or Position | OWNER
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Name | YAKOV FUZAYLOV
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Credential |
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Telephone | 718-470-2320
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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 |
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License Number State |
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