Provider Demographics
NPI:1811045016
Name:SHIMANOV, LEONID (DDS)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:SHIMANOV
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 1:18249 80TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1403
Mailing Address - Country:US
Mailing Address - Phone:718-662-8550
Mailing Address - Fax:718-707-0812
Practice Address - Street 1:4705 44TH ST
Practice Address - Street 2:APT. A-2
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6348
Practice Address - Country:US
Practice Address - Phone:718-752-9000
Practice Address - Fax:718-707-0812
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0489781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice