Provider Demographics
NPI:1285890350
Name:ISAKOV, VLADIMIR (DDS)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:ISAKOV
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 1:8532 123RD ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3317
Mailing Address - Country:US
Mailing Address - Phone:718-441-5016
Mailing Address - Fax:
Practice Address - Street 1:7064 KISSENA BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2245
Practice Address - Country:US
Practice Address - Phone:718-268-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice