Provider Demographics
NPI:1144304932
Name:YUSUFOV, NAMIK (DDS)
Entity type:Individual
Prefix:MR
First Name:NAMIK
Middle Name:
Last Name:YUSUFOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MORRIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8214
Mailing Address - Country:US
Mailing Address - Phone:732-728-7075
Mailing Address - Fax:732-728-0337
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-728-7075
Practice Address - Fax:732-728-0337
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102275700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist