Provider Demographics
NPI:1760174767
Name:COJOCARU, TATIANA (DMD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:COJOCARU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 CALLOWAY ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3802
Mailing Address - Country:US
Mailing Address - Phone:917-561-2672
Mailing Address - Fax:
Practice Address - Street 1:3135 COLUMBIA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7833
Practice Address - Country:US
Practice Address - Phone:917-561-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN278911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice