Individual
DR. AZARIY YUSUPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
349 E NORTHFIELD RD, SUITE 207, LIVINGSTON, NJ 07039-4802
(973) 535-4300
Mailing address
63-60 102ND STREET, #D18, REGO PARK, NY 11374
(718) 897-3940
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DIO2344900
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
052860
NY
Other
Enumeration date
06/13/2007
Last updated
01/26/2018
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