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NPI Code Detail

MEDICARE: YURIY NEKTALOV, DDS, PC

MEDICARE: YURIY NEKTALOV, DDS, PC
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
1122300000XDentist047891NY

General Provider Information

NPI Number : 1700039807
Entity Type Code : Organization
Provider Name (Legal Business Name) : YURIY NEKTALOV, DDS, PC
Provider Business Mailing Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 718-997-7762
Fax Number : 718-897-9060
Provider Business Practice Location Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 718-997-7762
Fax Number : 718-897-9060
Authorized Official
Title or Position : DENTIST
Name : DR. YURIY NEKTALOV
Credential : DDS
Telephone Number : 718-997-7762
Provider Enumeration Date : 11/03/2008
Last Update Date : 11/03/2008

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