Provider Demographics
NPI:1316343387
Name:KHABENSKY, IGOR (DDS)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:KHABENSKY
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 1:2426 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2004
Mailing Address - Country:US
Mailing Address - Phone:917-846-5305
Mailing Address - Fax:
Practice Address - Street 1:1615 QUENTIN RD STE A1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1295
Practice Address - Country:US
Practice Address - Phone:917-846-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY058143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program