Provider Demographics
NPI:1154484426
Name:YAKUBOVA, OKSANA (DDS)
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:YAKUBOVA
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 1:9945 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3652
Mailing Address - Country:US
Mailing Address - Phone:718-459-9560
Mailing Address - Fax:
Practice Address - Street 1:161 MADISON AVE RM 8NE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5467
Practice Address - Country:US
Practice Address - Phone:212-532-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02592345Medicaid