Provider Demographics
NPI:1619079373
Name:COYUKIAT, JUDY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:COYUKIAT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MACE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2400
Mailing Address - Country:US
Mailing Address - Phone:845-268-9723
Mailing Address - Fax:
Practice Address - Street 1:10 MACE DR
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2400
Practice Address - Country:US
Practice Address - Phone:845-268-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347439Medicaid