Individual
JONATHAN LEVI FAYZAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10834 67TH DRIVE, FOREST HILLS, NY 11375
(347) 982-5717
Mailing address
10834 67TH DRIVE, FOREST HILLS, NY 11375
(347) 985-5717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13907
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2023
Last updated
07/07/2024
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