Provider Demographics
NPI:1699817379
Name:FATAKHOVA, VIKTORIYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIKTORIYA
Middle Name:
Last Name:FATAKHOVA
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 1:16915 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5217
Mailing Address - Country:US
Mailing Address - Phone:718-523-0401
Mailing Address - Fax:718-523-0401
Practice Address - Street 1:16915 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5217
Practice Address - Country:US
Practice Address - Phone:718-523-0401
Practice Address - Fax:718-523-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist