Provider Demographics
NPI:1457404808
Name:KANATOV, VALERIY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VALERIY
Middle Name:
Last Name:KANATOV
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 1:421 HUGUENOT STREET
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING SUITE 3
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7004
Mailing Address - Country:US
Mailing Address - Phone:914-632-4446
Mailing Address - Fax:
Practice Address - Street 1:421 HUGUENOT STREET
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING SUITE 3
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7004
Practice Address - Country:US
Practice Address - Phone:914-632-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145715Medicaid