Provider Demographics
NPI:1215424130
Name:ZAKINOV, OKSANA KROSHNA (DDS)
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:KROSHNA
Last Name:ZAKINOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:OKSANA
Other - Middle Name:
Other - Last Name:KROSHNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6800 PALM AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4251
Mailing Address - Country:US
Mailing Address - Phone:718-683-4684
Mailing Address - Fax:
Practice Address - Street 1:6800 PALM AVE STE C1
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4251
Practice Address - Country:US
Practice Address - Phone:707-869-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice