Provider Demographics
NPI:1851434021
Name:AVNER, JACOB ALAYEV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALAYEV
Last Name:AVNER
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 1:9725 64TH AVE STE G3
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2205
Mailing Address - Country:US
Mailing Address - Phone:718-275-7300
Mailing Address - Fax:718-275-7307
Practice Address - Street 1:9725 64TH AVE STE G3
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2205
Practice Address - Country:US
Practice Address - Phone:718-275-7300
Practice Address - Fax:718-275-7307
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02282222Medicaid