Individual
DARIA VASILYEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
630 W 168TH ST, NEW YORK, NY 10032-3725
(212) 305-4552
Mailing address
630 W 168TH ST PH 15-1562, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
062977
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
N/A
—
Enumeration date
05/13/2019
Last updated
01/02/2024
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