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Individual

IRINA ILYAYEVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
3080 ATLANTIC AVE, BROOKLYN, NY 11208
(718) 896-4023
Mailing address
6260 99 STREET APT 1120, REGO PARK, NY 11374
(718) 896-4023

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0497051
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02289412
NY
Enumeration date
08/24/2006
Last updated
07/08/2007
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