Individual
DR. ISAAC DATIKASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
130 E 63RD ST OFC 1A, NEW YORK, NY 10021-7334
(212) 486-9458
Mailing address
130 E 63RD ST OFC 1A, NEW YORK, NY 10021-7334
(212) 486-9458
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052620
NY
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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