Provider Demographics
NPI:1265632798
Name:GUBENKO, NATALIYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIYA
Middle Name:
Last Name:GUBENKO
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 1:1810 JEROME AVE
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3621
Mailing Address - Country:US
Mailing Address - Phone:718-615-2030
Mailing Address - Fax:718-615-2030
Practice Address - Street 1:1810 JEROME AVE
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3621
Practice Address - Country:US
Practice Address - Phone:718-615-2030
Practice Address - Fax:718-615-2030
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663405Medicaid