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Organization
VICTORIA DENTAL PLLC
Active
Organization
VICTORIA DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT FATAKHOV DDS (DENTIST/MEMBER)
(917) 291-4232
Entity
Organization
Contact information
Practice address
3118 STEINWAY ST, ASTORIA, NY 11103-3909
(718) 728-7812
Mailing address
9945 65TH RD, REGO PARK, NY 11374-3654
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
054434
NY
Other
Enumeration date
03/03/2011
Last updated
03/03/2011
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