Provider Demographics
NPI:1316131006
Name:KOVAL, YURIY Z (DDS)
Entity type:Individual
Prefix:DR
First Name:YURIY
Middle Name:Z
Last Name:KOVAL
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 1:1250 MANN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5543
Mailing Address - Country:US
Mailing Address - Phone:704-234-0138
Mailing Address - Fax:855-273-3784
Practice Address - Street 1:1250 MANN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5543
Practice Address - Country:US
Practice Address - Phone:704-234-0138
Practice Address - Fax:855-273-3784
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907990Medicaid