Provider Demographics
NPI:1316615214
Name:KALASHNIKOVA, TATIANA (DDS)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KALASHNIKOVA
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 1:2077 E 12TH ST APT A3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2731
Mailing Address - Country:US
Mailing Address - Phone:646-651-9296
Mailing Address - Fax:
Practice Address - Street 1:2077 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2727
Practice Address - Country:US
Practice Address - Phone:646-651-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26099122300000X
NJ22DI02864200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist