Provider Demographics
NPI:1487826954
Name:KOTLYAR, YURY (DDS)
Entity type:Individual
Prefix:DR
First Name:YURY
Middle Name:
Last Name:KOTLYAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 OCEAN AVE
Mailing Address - Street 2:SUITE A 10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7328
Mailing Address - Country:US
Mailing Address - Phone:718-998-6700
Mailing Address - Fax:
Practice Address - Street 1:2044 OCEAN AVE
Practice Address - Street 2:SUITE A 10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7328
Practice Address - Country:US
Practice Address - Phone:718-998-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01235854Medicaid