Provider Demographics
NPI:1023267176
Name:TAFT, YULIYA (DDS)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:TAFT
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 1:2233 83RD ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2688
Mailing Address - Country:US
Mailing Address - Phone:212-844-9166
Mailing Address - Fax:
Practice Address - Street 1:2233 83RD ST APT 4C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2688
Practice Address - Country:US
Practice Address - Phone:212-844-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02781244Medicaid