Provider Demographics
NPI:1821720095
Name:GURULEV, DENIS
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:
Last Name:GURULEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511-1526
Mailing Address - Country:US
Mailing Address - Phone:347-286-6345
Mailing Address - Fax:
Practice Address - Street 1:1160 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6045
Practice Address - Country:US
Practice Address - Phone:575-652-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD56471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice