Provider Demographics
NPI:1306179213
Name:POHORLETSKA, TETYANA (DDS)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:POHORLETSKA
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 1:65 GLENBROOK RD
Mailing Address - Street 2:APT. 7E
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2970
Mailing Address - Country:US
Mailing Address - Phone:203-517-9507
Mailing Address - Fax:
Practice Address - Street 1:65 GLENBROOK RD
Practice Address - Street 2:APT. 7E
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2970
Practice Address - Country:US
Practice Address - Phone:203-517-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice