Provider Demographics
NPI:1346251352
Name:KATAYEV, BENJAMIN VLAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:VLAD
Last Name:KATAYEV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 DEKRUIE PLACE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:718-379-1700
Mailing Address - Fax:718-379-8921
Practice Address - Street 1:1401 DEKRUIE PLACE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:718-379-1700
Practice Address - Fax:718-379-8921
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0477111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01896900Medicaid