Provider Demographics
NPI:1235517061
Name:ISAKOV, GAIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAIANA
Middle Name:
Last Name:ISAKOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GAIANA
Other - Middle Name:
Other - Last Name:BAGUMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4857
Mailing Address - Country:US
Mailing Address - Phone:347-879-2967
Mailing Address - Fax:
Practice Address - Street 1:590 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-3217
Practice Address - Country:US
Practice Address - Phone:631-477-6777
Practice Address - Fax:631-477-6477
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0586901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice