Provider Demographics
NPI:1295264752
Name:ROGOZHKINA, KRISTINA VADIMOVNA (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:VADIMOVNA
Last Name:ROGOZHKINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:VADIMOVNA
Other - Last Name:ROGOZHKINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2599 WADSWORTH BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5640
Mailing Address - Country:US
Mailing Address - Phone:303-421-4820
Mailing Address - Fax:303-421-4822
Practice Address - Street 1:2599 WADSWORTH BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5640
Practice Address - Country:US
Practice Address - Phone:303-421-4820
Practice Address - Fax:303-421-4822
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002051861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6948OtherDEA