Individual
BORIS DAVYDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5645 MAIN ST, FLUSHING, NY 11355-5045
(718) 670-2000
Mailing address
10849 63RD AVE APT 1P, FOREST HILLS, NY 11375-1360
(347) 702-3054
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12611
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/03/2018
Last updated
08/13/2019
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