Provider Demographics
NPI:1093348088
Name:MAGLEVANNAYA, NATALIA
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:MAGLEVANNAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 SHEEPSHEAD BAY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3606
Mailing Address - Country:US
Mailing Address - Phone:718-769-4300
Mailing Address - Fax:718-891-5295
Practice Address - Street 1:1719 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3606
Practice Address - Country:US
Practice Address - Phone:718-769-4300
Practice Address - Fax:718-891-5295
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046962-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist