Provider Demographics
NPI:1396904819
Name:MAKSUMOVA, YULIYA (DDS)
Entity type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:
Last Name:MAKSUMOVA
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 1:8383 118TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2437
Mailing Address - Country:US
Mailing Address - Phone:718-805-8180
Mailing Address - Fax:
Practice Address - Street 1:15705 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2721
Practice Address - Country:US
Practice Address - Phone:718-591-5450
Practice Address - Fax:718-591-5452
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice