Active NPI
Dmitry Gorbunov, DDS
- General Practice Dentistry
- Elmhurst, NY
National Provider Identifier
1508919820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 043066-1
- Practice address
- 9123 Queens Blvd
Elmhurst, NY 11373-5531 - Phone
- (718) 943-8680
- Fax
- (718) 943-8683
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 043066-1 | NY | Primary |
Addresses
Primary practice location
9123 Queens Blvd
Elmhurst, NY 11373-5531
Mailing address
9123 Queens Blvd
Elmhurst, NY 11373-5531
Phone (718) 943-8680
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9178486 | Other | NY | DORAL |
| 01214108 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043066-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788652800000",
"number": "1508919820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9123 QUEENS BLVD",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113735531",
"telephone_number": "718-943-8680",
"fax_number": "718-943-8683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9123 QUEENS BLVD",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113735531",
"telephone_number": "718-943-8680",
"fax_number": "718-943-8683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORBUNOV",
"first_name": "DMITRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2026-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "043066-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL",
"identifier": "9178486",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01214108",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.