Individual
ALTAY KHANMAMEDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
315 W 57TH ST, SUITE 209, NEW YORK, NY 10019-3158
(917) 338-6358
(917) 470-9486
Mailing address
801 WEST 181 ST, #26, NEW YORK, NY 10033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051162
NY
Other
Enumeration date
04/18/2006
Last updated
01/08/2010
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