Provider Demographics
NPI:1518342856
Name:KAYLAKOV, BORIS (DDS)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:KAYLAKOV
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 1:9825 64TH RD APT 7G
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3402
Mailing Address - Country:US
Mailing Address - Phone:917-743-5317
Mailing Address - Fax:
Practice Address - Street 1:9825 64TH RD APT 7G
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3402
Practice Address - Country:US
Practice Address - Phone:917-743-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist