Provider Demographics
NPI:1306069554
Name:NEMTSEVA, YANA (DDS)
Entity type:Individual
Prefix:DR
First Name:YANA
Middle Name:
Last Name:NEMTSEVA
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 1:2001 AVENUE P APT A4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1420
Mailing Address - Country:US
Mailing Address - Phone:718-339-8400
Mailing Address - Fax:718-998-5708
Practice Address - Street 1:2001 AVENUE P APT A4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1420
Practice Address - Country:US
Practice Address - Phone:718-339-8400
Practice Address - Fax:718-998-5708
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554007Medicaid