Provider Demographics
NPI:1669400693
Name:ZINKOVETSKAYA, SOFIYA (DDS)
Entity type:Individual
Prefix:DR
First Name:SOFIYA
Middle Name:
Last Name:ZINKOVETSKAYA
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 1:105 OCEANA DR E
Mailing Address - Street 2:APT. 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6681
Mailing Address - Country:US
Mailing Address - Phone:718-300-7519
Mailing Address - Fax:718-282-8003
Practice Address - Street 1:1208 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7005
Practice Address - Country:US
Practice Address - Phone:718-282-8004
Practice Address - Fax:718-282-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02238071Medicaid