Provider Demographics
NPI:1023261682
Name:NOSOV, MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NOSOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MIKHAIL
Other - Middle Name:
Other - Last Name:NOSOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2250 83RD ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2661
Mailing Address - Country:US
Mailing Address - Phone:716-628-4971
Mailing Address - Fax:
Practice Address - Street 1:3305 JERUSALEM AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2028
Practice Address - Country:US
Practice Address - Phone:716-628-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist