Provider Demographics
NPI:1356342588
Name:GORIOUNOV, EVGENI (DDS)
Entity type:Individual
Prefix:
First Name:EVGENI
Middle Name:
Last Name:GORIOUNOV
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 1:6 CHAPEL HILL CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1302
Mailing Address - Country:US
Mailing Address - Phone:917-921-8519
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1707
Practice Address - Country:US
Practice Address - Phone:973-471-8300
Practice Address - Fax:973-471-6662
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020941001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice