Provider Demographics
NPI:1912017617
Name:NEKTALOV, YURIY (DDS)
Entity Type:Individual
Prefix:
First Name:YURIY
Middle Name:
Last Name:NEKTALOV
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 1:9424 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2028
Mailing Address - Country:US
Mailing Address - Phone:718-997-7762
Mailing Address - Fax:718-897-9060
Practice Address - Street 1:9424 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2028
Practice Address - Country:US
Practice Address - Phone:718-997-7762
Practice Address - Fax:718-897-9060
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0478911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01899389Medicaid