Provider Demographics
NPI:1609036219
Name:MAKHNEVICH, STACY (DDS)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MAKHNEVICH
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 1:405 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10174-0002
Mailing Address - Country:US
Mailing Address - Phone:917-832-1355
Mailing Address - Fax:917-832-1355
Practice Address - Street 1:405 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10174-0002
Practice Address - Country:US
Practice Address - Phone:917-832-1355
Practice Address - Fax:917-832-1355
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051437122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist