Provider Demographics
NPI:1376623900
Name:STRELKOV, LARISA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:LARISA
Middle Name:
Last Name:STRELKOV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:SUITE 1105A
Mailing Address - City:YARALEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-7000
Mailing Address - Fax:215-493-7002
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 1105A
Practice Address - City:YARALEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-493-7000
Practice Address - Fax:215-493-7002
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029534L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0774792OtherBCBS
PA21026744OtherDELTA