Provider Demographics
NPI:1972332419
Name:DERYABIN, GEORGII (DDS)
Entity type:Individual
Prefix:
First Name:GEORGII
Middle Name:
Last Name:DERYABIN
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 1:1100 FLORIDA AVENUE, BOX 18, ROOM 5321, NEW ORLEANS, L
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-941-8212
Mailing Address - Fax:504-941-8215
Practice Address - Street 1:1100 FLORIDA AVENUE,
Practice Address - Street 2:BOX 18, ROOM 5321, NEW ORLEANS LOUISIANA 70119-2799
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-941-8212
Practice Address - Fax:504-941-8215
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program