Boutique Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

055256 Issued in NY

Legal business name

BOUTIQUE DENTAL

Practice address

6835 Myrtle Ave
Glendale, NY 11385-7234

Phone

(718) 821-0170

NPI assigned

May 7, 2013

Last updated

Jul 19, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Yelena M Mullakandova, DDSNPI 1801103726

Title

Owner/Dentist

Phone

(917) 640-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Glendale Boutique DentAL Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yelena Mullakandova, D.D.S

  • Dentist
  • Forest Hills, NY
  • NPI 1801103726
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405728000000",
    "number": "1285079962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6835 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857234",
            "telephone_number": "718-821-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6835 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857234",
            "telephone_number": "718-821-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUTIQUE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2014-07-19",
        "status": "A",
        "authorized_official_last_name": "MULLAKANDOVA",
        "authorized_official_first_name": "YELENA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "917-640-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "055256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03263605",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glendale Boutique DentAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jonny Boiardi
• Alexander Boston
• Hanan Botros
• Jacqueline Bottenbley, MS.ED
• Soukaina Boudari
• Jessica Marie Bradley, PT, DPT
• Brand Medical Supply, Inc.
• Marc Alan Brenner, D.P.M.
• Ted Brezel, M.D.
• Glenda Bria, PT

• Dental Clinic/Center in Glendale, NY
• Providers in Glendale, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.