Provider Demographics
NPI:1437284940
Name:KREPKH, MARINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KREPKH
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 1:20 E ROCKAWAY RD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1710
Mailing Address - Country:US
Mailing Address - Phone:917-513-7344
Mailing Address - Fax:
Practice Address - Street 1:7708 4TH AVE
Practice Address - Street 2:1SRT FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3402
Practice Address - Country:US
Practice Address - Phone:718-491-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist