Organization
AFAM DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT FATAKHOV DDS (DENTIST)
(917) 291-4232
Entity
Organization
Contact information
Practice address
5205 CHURCH AVE, BROOKLYN, NY 11203-3513
(917) 291-4232
Mailing address
5205 CHURCH AVE, BROOKLYN, NY 11203-3513
(917) 291-4232
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
051345
NY
122300000X
Dentist
053061
NY
122300000X
Dentist
Primary
054434
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02758212
—
NY
05
—
02817352
—
NY
05
—
03157206
—
NY
Enumeration date
02/02/2011
Last updated
02/02/2011
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