MEDICARE: DR. IRINA YESINA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	048514	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	571158184	OTHER	NY	TAX I.D
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548293012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRINA YESINA DDS

Provider Business Mailing Address
First Line	:	602 FLATBUSH AVE
Second Line	:	C/O DENTAL OFFICE
City	:	BROOKLYN
State	:	NY
Zip	:	11225
Country	:	US
Telephone Number	:	718-778-7600
Fax Number	:	718-778-7677

Provider Business Practice Location Address
First Line	:	711 NOSTRAND AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3940
Country	:	US
Telephone Number	:	718-778-7600
Fax Number	:	718-778-7677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/22/2016

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