Provider Demographics
NPI:1902975261
Name:SVICHAR, INNA (DDS)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SVICHAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 72ND DR
Mailing Address - Street 2:APT.D62
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5661
Mailing Address - Country:US
Mailing Address - Phone:718-793-7499
Mailing Address - Fax:
Practice Address - Street 1:8450 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1721
Practice Address - Country:US
Practice Address - Phone:718-441-4020
Practice Address - Fax:718-441-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02062242Medicaid