Fattakhov, Ezro
Fattakhov, Ezro is an individual health care provider with primary practice located at 10510 62Nd Rd Apt 1F, Forest Hills NY 11375-1137. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Fattakhov, Ezro can be contacted via phone (718) 760-8400.Contact Information
Primary practice address
10510 62Nd Rd Apt 1F
Forest Hills NY 11375-1137
Phone: (718) 760-8400
Fax: (718) 760-8114
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 046846 | New York |
Profile Details
| NPI number | 1811046741 |
|---|---|
| LBN Legal business name | Fattakhov, Ezro |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 9th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811046741 | NPPES |
| New York | MEDICAID | 01773835 |
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