Provider Demographics
NPI:1548293012
Name:YESINA, IRINA (DDS)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:YESINA
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 1:602 FLATBUSH AVE
Mailing Address - Street 2:C/O DENTAL OFFICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225
Mailing Address - Country:US
Mailing Address - Phone:718-778-7600
Mailing Address - Fax:718-778-7677
Practice Address - Street 1:711 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3940
Practice Address - Country:US
Practice Address - Phone:718-778-7600
Practice Address - Fax:718-778-7677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY571158184OtherTAX I.D
NY02051009Medicaid