Provider Demographics
NPI:1831231398
Name:KANATOVA, YULIYA (DDS)
Entity type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:
Last Name:KANATOVA
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 1:1 AVE AT PORT IMPERIAL
Mailing Address - Street 2:APT 1250
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8345
Mailing Address - Country:US
Mailing Address - Phone:917-716-8332
Mailing Address - Fax:
Practice Address - Street 1:29 W 19TH ST
Practice Address - Street 2:UNION SQUARE DENTAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4232
Practice Address - Country:US
Practice Address - Phone:212-675-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice