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General NPI Number Information
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NPI Number | 1972332419
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Entity Type | Individual
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Provider Name | GEORGII DERYABIN DDS
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Gender | Male
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1100 FLORIDA AVENUE, BOX 18, ROOM 5321, NEW ORLEANS LOUISIANA 70119-2799
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City | NEW ORLEANS
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State | LA
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Zip | 70119
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Country | US
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Telephone | 504-941-8212
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Fax | 504-941-8215
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Provider Business Mailing Address
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Address Line | 1100 FLORIDA AVENUE, BOX 18, ROOM 5321, NEW ORLEANS, L
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City | NEW ORLEANS
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State | LA
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Zip | 70119
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Country | US
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Telephone | 504-941-8212
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Fax | 504-941-8215
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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