Provider Demographics
NPI:1932321916
Name:FINGEROV, IRINA (GENERAL DENTIST)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:FINGEROV
Suffix:
Gender:F
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 RESEDA BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-8417
Mailing Address - Country:US
Mailing Address - Phone:818-882-0009
Mailing Address - Fax:818-609-7569
Practice Address - Street 1:4430 NOBLE AVE APT 303
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4076
Practice Address - Country:US
Practice Address - Phone:818-882-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice