Provider Demographics
NPI:1295725984
Name:YAKUBOV, YURIY (DDS)
Entity type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:YAKUBOV
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 1:10719 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4318
Mailing Address - Country:US
Mailing Address - Phone:718-263-8469
Mailing Address - Fax:
Practice Address - Street 1:6612 102ND ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4524
Practice Address - Country:US
Practice Address - Phone:718-997-6660
Practice Address - Fax:718-997-8118
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0477211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01865223Medicaid