Individual
DR. DMITRY GORBUNOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9123 QUEENS BLVD, ELMHURST, NY 11373-5531
(718) 943-8680
(718) 943-8683
Mailing address
9123 QUEENS BLVD, ELMHURST, NY 11373-5531
(718) 943-8680
(718) 943-8683
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
043066-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01214108
—
NY
01
—
9178486
DORAL
NY
Enumeration date
01/19/2007
Last updated
01/12/2009
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