Provider Demographics
NPI:1326186503
Name:MEDVED, YULIYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:
Last Name:MEDVED
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 1:119 MINER RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-6103
Mailing Address - Country:US
Mailing Address - Phone:518-483-8157
Mailing Address - Fax:
Practice Address - Street 1:14 MINER ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1286
Practice Address - Country:US
Practice Address - Phone:315-379-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice