Individual
MR. IOSIF AVEZBADALOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6384 SAUNDERS ST, REGO PARK, NY 11374
(718) 997-7762
Mailing address
6411 99TH ST, #110, REGO PARK, NY 11374
(718) 997-0095
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
050720
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02521951
—
NY
Enumeration date
02/09/2007
Last updated
07/08/2007
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