Provider Demographics
NPI:1720150626
Name:GEORGIO, YULA (DMD)
Entity Type:Individual
Prefix:DR
First Name:YULA
Middle Name:
Last Name:GEORGIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16032 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3905
Mailing Address - Country:US
Mailing Address - Phone:718-357-8800
Mailing Address - Fax:718-357-8818
Practice Address - Street 1:16032 20TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3905
Practice Address - Country:US
Practice Address - Phone:718-357-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0444001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY810612301Medicare UPIN