Provider Demographics
NPI:1194714501
Name:SEMENENKOVA, YANINA
Entity type:Individual
Prefix:
First Name:YANINA
Middle Name:
Last Name:SEMENENKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 OCEAN AVE
Mailing Address - Street 2:S.A-6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4557
Mailing Address - Country:US
Mailing Address - Phone:718-646-7271
Mailing Address - Fax:
Practice Address - Street 1:2662 OCEAN AVE
Practice Address - Street 2:S.A-6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4557
Practice Address - Country:US
Practice Address - Phone:718-646-7271
Practice Address - Fax:718-646-6664
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice