Provider Demographics
NPI:1669826905
Name:SHUMINOV, RADMILA (DDS)
Entity Type:Individual
Prefix:
First Name:RADMILA
Middle Name:
Last Name:SHUMINOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RADMILA
Other - Middle Name:
Other - Last Name:RAFAILOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3071 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5122
Mailing Address - Country:US
Mailing Address - Phone:718-736-0123
Mailing Address - Fax:
Practice Address - Street 1:3071 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5122
Practice Address - Country:US
Practice Address - Phone:718-736-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY059175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program