Provider Demographics
NPI:1336494939
Name:KANDOV, INESSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:INESSA
Middle Name:
Last Name:KANDOV
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 1:21333 39TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2092
Mailing Address - Country:US
Mailing Address - Phone:718-734-2888
Mailing Address - Fax:718-734-2899
Practice Address - Street 1:21333 39TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2092
Practice Address - Country:US
Practice Address - Phone:718-734-2888
Practice Address - Fax:718-734-2899
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0560611223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice