Provider Demographics
NPI:1972560571
Name:DR KATERINA GONCHAROVA DDS PLC
Entity type:Organization
Organization Name:DR KATERINA GONCHAROVA DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EKATERINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GONCHAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-986-5860
Mailing Address - Street 1:2853 S SOSSAMAN RD
Mailing Address - Street 2:A110
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212
Mailing Address - Country:US
Mailing Address - Phone:480-986-5860
Mailing Address - Fax:480-986-5870
Practice Address - Street 1:2853 S SOSSAMAN RD
Practice Address - Street 2:A110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212
Practice Address - Country:US
Practice Address - Phone:480-986-5860
Practice Address - Fax:480-986-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty