Individual
SERGEI A KUZNETSOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
506 6TH ST, BROOKLYN, NY 11215-3609
(480) 286-2366
Mailing address
441 2ND ST APT 2R, BROOKLYN, NY 11215-2520
(480) 286-2366
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6538
LA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
061202
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083031553
DENTAL
NY
Enumeration date
03/23/2014
Last updated
09/25/2023
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