Provider Demographics
NPI:1174939557
Name:YUSUPOV, LEV (DDS)
Entity type:Individual
Prefix:
First Name:LEV
Middle Name:
Last Name:YUSUPOV
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 1:1185 NORTHERN BLVD
Mailing Address - Street 2:DENTAL CARE OF MANHASSET, P.C.
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3017
Mailing Address - Country:US
Mailing Address - Phone:516-441-5142
Mailing Address - Fax:516-441-5146
Practice Address - Street 1:1185 NORTHERN BLVD
Practice Address - Street 2:DENTAL CARE OF MANHASSET
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3017
Practice Address - Country:US
Practice Address - Phone:516-441-5142
Practice Address - Fax:516-441-5146
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0575031223G0001X
CT112021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice