Organization
IGOR ILYABAYEV D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IGOR ILYABAYEV D.D.S. (DENTIST)
(516) 887-0020
Entity
Organization
Contact information
Practice address
139 N CENTRAL AVE STE 3, VALLEY STREAM, NY 11580-3859
(516) 887-0020
Mailing address
139 N CENTRAL AVE STE 3, VALLEY STREAM, NY 11580-3859
(516) 887-0020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052814
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03168361
—
NY
Enumeration date
01/07/2010
Last updated
01/05/2017
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