Provider Demographics
NPI:1407938178
Name:NIKIFOROUK, LIOUDMILA (DDS)
Entity Type:Individual
Prefix:
First Name:LIOUDMILA
Middle Name:
Last Name:NIKIFOROUK
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:PO BOX 827658
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7658
Mailing Address - Country:US
Mailing Address - Phone:570-476-3754
Mailing Address - Fax:570-476-3507
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:SUITE 114
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-476-3506
Practice Address - Fax:570-420-2408
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist