Provider Demographics
NPI:1982797387
Name:ABAYEV, IGOR (DDS)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:ABAYEV
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 1:8411 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1531
Mailing Address - Country:US
Mailing Address - Phone:718-424-7100
Mailing Address - Fax:
Practice Address - Street 1:8411 NORTHERN BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1531
Practice Address - Country:US
Practice Address - Phone:718-424-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02799062Medicaid