Provider Demographics
NPI:1215135074
Name:KAKOSYAN, IRENE (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KAKOSYAN
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 1:163 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1104
Mailing Address - Country:US
Mailing Address - Phone:212-661-9777
Mailing Address - Fax:212-661-9779
Practice Address - Street 1:405 LEXINGTON AVE
Practice Address - Street 2:FLOOR 21
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10174-0002
Practice Address - Country:US
Practice Address - Phone:212-661-9777
Practice Address - Fax:212-661-9779
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049136-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice