Provider Demographics
NPI:1417473273
Name:DOROSHENKO, ANDREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:DOROSHENKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARK CENTER CT STE 302
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4203
Mailing Address - Country:US
Mailing Address - Phone:410-356-7799
Mailing Address - Fax:
Practice Address - Street 1:5 PARK CENTER CT STE 302
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4203
Practice Address - Country:US
Practice Address - Phone:410-356-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics