Yakov Fuzaylov Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

YAKOV FUZAYLOV DENTAL PC

Doing business as

Premier Dental

Practice address

7835 B Springfield Blvd
Queens Village, NY 11364

Phone

(718) 470-2320

Fax

(718) 470-2321

NPI assigned

Nov 18, 2021

Last updated

Nov 18, 2021By 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

Yakov FuzaylovNPI 1043524200

Title

Owner

Phone

(718) 470-2320

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Premier Dental Doing business as

Locations

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.

• Yakov Fuzaylov, DDS

  • Dentist
  • Oakland Gardens, NY
  • NPI 1043524200

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637193600000",
    "number": "1932866514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7835 B SPRINGFIELD BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11364",
            "telephone_number": "718-470-2320",
            "fax_number": "718-470-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7835 B SPRINGFIELD BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11364",
            "telephone_number": "718-470-2320",
            "fax_number": "718-470-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAKOV FUZAYLOV DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-18",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A",
        "authorized_official_last_name": "FUZAYLOV",
        "authorized_official_first_name": "YAKOV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-470-2320"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03271583",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shara Serena Wright, RN
• Shirnet Wright, CNA
• Jie Wu
• Sharon Wu
• Chacko Xaviour
• Jair Yepez Torres, BCBA, LBA
• Bonny Yohannan, RN
• Joong H Yoo
• Hyungjun Yoon
• Mina Youn, LMSW

• General Practice Dentistry in Queens Village, NY
• Providers in Queens Village, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; 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.