Provider Demographics
NPI:1477966414
Name:STRONG, EKATERINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:NEMTSEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:301 NE 14TH AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1417
Practice Address - Country:US
Practice Address - Phone:802-862-8348
Practice Address - Fax:802-862-6823
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 206281223G0001X
VT016.01330951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1031000Medicaid