Individual
MOISEY FAZYLOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8519 65TH AVE, FLUSHING, NY 11374-5039
(347) 880-2885
Mailing address
8519 65TH AVE, FLUSHING, NY 11374-5039
(347) 880-2885
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
062017
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2020
Last updated
09/24/2021
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