Provider Demographics
NPI:1598358988
Name:MULLOKANDOV, AVNER COHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:AVNER
Middle Name:COHEN
Last Name:MULLOKANDOV
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MADISON AVE RM 202
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0717
Mailing Address - Country:US
Mailing Address - Phone:212-227-4600
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON AVE RM 202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0717
Practice Address - Country:US
Practice Address - Phone:212-227-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY062742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program