Provider Demographics
NPI:1699400689
Name:BOBROVA, OLESSYA (DDS)
Entity Type:Individual
Prefix:
First Name:OLESSYA
Middle Name:
Last Name:BOBROVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W 29TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4707
Mailing Address - Country:US
Mailing Address - Phone:646-464-1581
Mailing Address - Fax:
Practice Address - Street 1:317 W 29TH ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4707
Practice Address - Country:US
Practice Address - Phone:646-464-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program