Provider Demographics
NPI:1932636388
Name:ABRAMOV, MARINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ABRAMOV
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 1:6115 98TH ST APT 3K
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1477
Mailing Address - Country:US
Mailing Address - Phone:917-291-4734
Mailing Address - Fax:
Practice Address - Street 1:6115 98TH ST APT 3K
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1477
Practice Address - Country:US
Practice Address - Phone:917-291-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0615791223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program