Individual
DR. EZRO FATTAKHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10510 62ND RD, APT 1F, FOREST HILLS, NY 11375-1137
(718) 760-8400
(718) 760-8114
Mailing address
9926 64TH RD, REGO PARK, NY 11374-2646
(718) 830-9091
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
046846
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01773835
—
NY
Enumeration date
01/09/2007
Last updated
07/08/2007
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