Organization
GY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORIY YUSUPOV DDS (DDS GENERAL DENTIST)
(718) 421-6300
Entity
Organization
Contact information
Practice address
1419 FOSTER AVE, BROOKLYN, NY 11230-1726
(718) 421-6300
(718) 421-6001
Mailing address
99-46 62 DRIVE, REGO PARK, NY 11374
(718) 421-6300
(718) 421-6001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
049312
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207692
—
NY
Enumeration date
04/16/2007
Last updated
08/22/2020
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