Provider Demographics
NPI:1871612838
Name:AULOVA, IRKYAM (DDS)
Entity type:Individual
Prefix:DR
First Name:IRKYAM
Middle Name:
Last Name:AULOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 OCEAN AVE
Mailing Address - Street 2:#5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3945
Mailing Address - Country:US
Mailing Address - Phone:718-615-2955
Mailing Address - Fax:718-615-2956
Practice Address - Street 1:2540 OCEAN AVE
Practice Address - Street 2:#5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3945
Practice Address - Country:US
Practice Address - Phone:718-615-2955
Practice Address - Fax:718-615-2956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691821Medicaid