Basic Information
| Provider Information | |||||||||
| NPI: | 1003006446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUKRINSKY | ||||||||
| FirstName: | VLADIMIR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1632 E 18TH ST | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112291268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183825565 | ||||||||
| FaxNumber: | 7183825590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1632 E 18TH ST | ||||||||
| Address2: | SUITE A-1 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112291268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183825565 | ||||||||
| FaxNumber: | 7183825590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 045247 | NY | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 01512876 | 05 | NY | MEDICAID |