Provider Demographics
NPI:1437320025
Name:DR. IRINA YESINA DDS.PC
Entity type:Organization
Organization Name:DR. IRINA YESINA DDS.PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YESINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-778-7600
Mailing Address - Street 1:711 NOSTRAND AVE
Mailing Address - Street 2:FAMILY DENTAL CARE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3940
Mailing Address - Country:US
Mailing Address - Phone:718-778-7600
Mailing Address - Fax:718-778-7677
Practice Address - Street 1:711 NOSTRAND AVE
Practice Address - Street 2:FAMILY DENTAL CARE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3940
Practice Address - Country:US
Practice Address - Phone:718-778-7600
Practice Address - Fax:718-778-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02051009Medicaid