Provider Demographics
NPI:1164563300
Name:YADGAROV, ZOYA (DDS)
Entity Type:Individual
Prefix:
First Name:ZOYA
Middle Name:
Last Name:YADGAROV
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 1:73-24 172 STREET
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-344-7848
Mailing Address - Fax:
Practice Address - Street 1:12 EAST 41 STREET SUITE 1002
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-535-3226
Practice Address - Fax:212-683-2577
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052161-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02842157Medicaid