Provider Demographics
NPI:1679922280
Name:ISRAILOV, BORIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:ISRAILOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9833 64TH AVE
Mailing Address - Street 2:APT 8B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2544
Mailing Address - Country:US
Mailing Address - Phone:646-387-3019
Mailing Address - Fax:
Practice Address - Street 1:9833 64TH AVE
Practice Address - Street 2:APT 8B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2544
Practice Address - Country:US
Practice Address - Phone:646-387-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059377-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist