Provider Demographics
NPI:1003007543
Name:EPELBOYM, DMITRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:EPELBOYM
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 1:7708 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3402
Mailing Address - Country:US
Mailing Address - Phone:718-491-3100
Mailing Address - Fax:718-491-2140
Practice Address - Street 1:7708 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3402
Practice Address - Country:US
Practice Address - Phone:718-491-3100
Practice Address - Fax:718-491-2140
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045076-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice