Provider Demographics
NPI:1831423409
Name:YAKUBOFF, JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:YAKUBOFF
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 1:181 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3626
Mailing Address - Country:US
Mailing Address - Phone:203-846-0200
Mailing Address - Fax:203-840-1958
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3626
Practice Address - Country:US
Practice Address - Phone:203-846-0200
Practice Address - Fax:203-840-1958
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice