Provider Demographics
NPI:1578051918
Name:AUSTIN, YESSENIA ANABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:YESSENIA
Middle Name:ANABEL
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YESSENIA
Other - Middle Name:ANABEL
Other - Last Name:BARRERA ANDRADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6601 BAY PKWY APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3937
Mailing Address - Country:US
Mailing Address - Phone:347-604-0563
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0608981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty