Provider Demographics
NPI:1538417332
Name:AMINOV, YULIAN (DDS)
Entity type:Individual
Prefix:
First Name:YULIAN
Middle Name:
Last Name:AMINOV
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 1:9949 66TH RD
Mailing Address - Street 2:APT# 5A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4463
Mailing Address - Country:US
Mailing Address - Phone:212-203-1611
Mailing Address - Fax:
Practice Address - Street 1:9949 66TH RD
Practice Address - Street 2:APT# 5A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4463
Practice Address - Country:US
Practice Address - Phone:212-203-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02511900122300000X
CT10859122300000X
CT0108591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist