Individual
DR. GURAM YAKOBASHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
(646) 404-5006
Mailing address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
(646) 404-5006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0558311
NY
1223G0001X
General Practice Dentistry
DI20280
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03395140
—
NY
05
—
8444706
—
NJ
Enumeration date
09/21/2006
Last updated
12/26/2012
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