Provider Demographics
NPI:1093955098
Name:ILYA YAGUDAYEV DDS, PC
Entity Type:Organization
Organization Name:ILYA YAGUDAYEV DDS, PC
Other - Org Name:AFFORDABLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-860-4176
Mailing Address - Street 1:517 PULASKI ST
Mailing Address - Street 2:OFFICE B
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:517 PULASKI ST
Practice Address - Street 2:OFFICE B
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3210
Practice Address - Country:US
Practice Address - Phone:516-860-4176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty