Provider Demographics
NPI:1891779823
Name:SVERDLOV, GRIGORIY A (DDS)
Entity Type:Individual
Prefix:MR
First Name:GRIGORIY
Middle Name:A
Last Name:SVERDLOV
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 1:348 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6834
Mailing Address - Country:US
Mailing Address - Phone:516-439-9290
Mailing Address - Fax:516-439-9290
Practice Address - Street 1:348 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-927-1117
Practice Address - Fax:212-927-0832
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0475671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01823312Medicaid
9176433OtherDORAL