Provider Demographics
NPI:1043335185
Name:BRANETS, IRYNA (DDS)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:BRANETS
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 1:1601 GRAVESEND NECK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4426
Mailing Address - Country:US
Mailing Address - Phone:718-934-0050
Mailing Address - Fax:718-934-0063
Practice Address - Street 1:1601 GRAVESEND NECK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4426
Practice Address - Country:US
Practice Address - Phone:718-934-0050
Practice Address - Fax:718-934-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172101223G0001X
NY053771-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02941940Medicaid