Individual
IRINA FUZAYLOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
120 NASSAU AVE, BROOKLYN, NY 11222-4024
(718) 490-2846
Mailing address
6909 138TH ST, APT#2C, FLUSHING, NY 11367-1603
(718) 490-2846
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052818
NY
Other
Enumeration date
02/06/2008
Last updated
08/24/2009
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