Individual
DR. ILLYA ALEX TARASENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
139 KANE ST, #4, BROOKLYN, NY 11231-5229
(267) 304-4701
Mailing address
139 KANE ST, #4, BROOKLYN, NY 11231-5229
(267) 304-4701
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
037413
PA
122300000X
Dentist
Primary
053958
NY
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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