Provider Demographics
NPI:1558630111
Name:NEMCHONOK, EVGENY (DDS)
Entity Type:Individual
Prefix:
First Name:EVGENY
Middle Name:
Last Name:NEMCHONOK
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 1:1058 N TAMIAMI TRL
Mailing Address - Street 2:#106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2416
Mailing Address - Country:US
Mailing Address - Phone:941-870-3322
Mailing Address - Fax:941-953-5959
Practice Address - Street 1:1058 N TAMIAMI TRL
Practice Address - Street 2:#106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2416
Practice Address - Country:US
Practice Address - Phone:941-870-3322
Practice Address - Fax:941-953-5959
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist