Provider Demographics
NPI:1649918012
Name:BORYS AVERBUKH DMD PLLC
Entity type:Organization
Organization Name:BORYS AVERBUKH DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORYS
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-424-5891
Mailing Address - Street 1:127 REVOLUTION WAY
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-6843
Mailing Address - Country:US
Mailing Address - Phone:347-424-5891
Mailing Address - Fax:
Practice Address - Street 1:10 PENDLETON DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1525
Practice Address - Country:US
Practice Address - Phone:347-424-5891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental