Provider Demographics
NPI:1689655482
Name:AVDEYCHIK, YEVGENY (DDS)
Entity Type:Individual
Prefix:MR
First Name:YEVGENY
Middle Name:
Last Name:AVDEYCHIK
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 1:1810 JEROME AVE
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3621
Mailing Address - Country:US
Mailing Address - Phone:718-646-0900
Mailing Address - Fax:718-769-9723
Practice Address - Street 1:1810 JEROME AVE
Practice Address - Street 2:1 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3621
Practice Address - Country:US
Practice Address - Phone:718-646-0900
Practice Address - Fax:718-769-9723
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01354269Medicaid
NY0135Y269Medicaid