Provider Demographics
NPI:1710325899
Name:LEFTA-HOSKINS, FOTINA (DMD)
Entity Type:Individual
Prefix:MS
First Name:FOTINA
Middle Name:
Last Name:LEFTA-HOSKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:LEFTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10270 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-0284
Mailing Address - Country:US
Mailing Address - Phone:502-244-1500
Mailing Address - Fax:502-244-1550
Practice Address - Street 1:10270 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2955
Practice Address - Country:US
Practice Address - Phone:502-244-1500
Practice Address - Fax:502-244-1550
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice