Provider Demographics
NPI:1417034869
Name:DOBROVA, ASYA
Entity Type:Individual
Prefix:
First Name:ASYA
Middle Name:
Last Name:DOBROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BEVERLEY RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3914
Mailing Address - Country:US
Mailing Address - Phone:718-854-3000
Mailing Address - Fax:718-854-3000
Practice Address - Street 1:108 BEVERLEY RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3914
Practice Address - Country:US
Practice Address - Phone:718-854-3000
Practice Address - Fax:718-854-3000
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice