Provider Demographics
NPI:1730708348
Name:BORUKHOV, SOLOMON DAVIDOVICH (DDS)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:DAVIDOVICH
Last Name:BORUKHOV
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 1:7925 150TH ST APT A2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3801
Mailing Address - Country:US
Mailing Address - Phone:718-964-3463
Mailing Address - Fax:
Practice Address - Street 1:14305 41ST AVE APT 1I
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1801
Practice Address - Country:US
Practice Address - Phone:718-359-3555
Practice Address - Fax:718-321-0531
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0619071223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program