Provider Demographics
NPI:1255476891
Name:VATRENKO, IRINA (DDS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:VATRENKO
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 1:84 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1420
Mailing Address - Country:US
Mailing Address - Phone:212-979-0990
Mailing Address - Fax:
Practice Address - Street 1:84 STANTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1420
Practice Address - Country:US
Practice Address - Phone:212-979-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0652311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice