Individual
YURIY YUSUPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
7901 4TH AVE STE A3, BROOKLYN, NY 11209-3970
(718) 745-0400
Mailing address
7901 4TH AVE STE A3, BROOKLYN, NY 11209-3970
(718) 745-0400
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
052623
NY
Other
Enumeration date
11/19/2008
Last updated
10/10/2011
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