Individual
DR. LARISA TAKHALOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6932 FLEET ST, FOREST HILLS, NY 11375-5148
(718) 670-1060
Mailing address
1465 WESTERN AVE, ALBANY, NY 12203-3512
(518) 512-3001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055646
NY
Other
Enumeration date
04/19/2010
Last updated
07/15/2017
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