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NPI Code Detail

MEDICARE: YURIY NEKTALOV DDS

MEDICARE: YURIY NEKTALOV 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
11223G0001XGeneral Practice Dentistry047891NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912017617
Entity Type Code : Individual
Provider Name (Legal Business Name) : YURIY NEKTALOV DDS
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/22/2008

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