Provider Demographics
NPI:1659372944
Name:BURAKOFF, RONALD PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:BURAKOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 YORK AVE
Mailing Address - Street 2:APARTMENT 26 G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6855
Mailing Address - Country:US
Mailing Address - Phone:718-470-7111
Mailing Address - Fax:718-347-4118
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1433
Practice Address - Country:US
Practice Address - Phone:718-470-7111
Practice Address - Fax:718-347-4118
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312231223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU59722Medicare UPIN