Provider Demographics
NPI:1134724354
Name:NATALIJA KOKOREVA DDS LLC
Entity type:Organization
Organization Name:NATALIJA KOKOREVA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOREVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-871-2296
Mailing Address - Street 1:2025 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2025 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7612
Practice Address - Country:US
Practice Address - Phone:503-654-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental