Provider Demographics
NPI:1992388243
Name:STOMACHENKO, ULIANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ULIANA
Middle Name:
Last Name:STOMACHENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ULIANA
Other - Middle Name:
Other - Last Name:ALONSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1 W DICKERSON ST APT 317
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4759
Mailing Address - Country:US
Mailing Address - Phone:917-780-7334
Mailing Address - Fax:
Practice Address - Street 1:17 S WARREN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4506
Practice Address - Country:US
Practice Address - Phone:973-328-9100
Practice Address - Fax:973-718-4645
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029053001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice