Provider Demographics
NPI:1376837500
Name:KOSTENKO, YULIYA (DMD)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KOSTENKO
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 1:74 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1115
Mailing Address - Country:US
Mailing Address - Phone:781-581-1411
Mailing Address - Fax:781-581-1433
Practice Address - Street 1:74 MARKET ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1115
Practice Address - Country:US
Practice Address - Phone:781-581-1411
Practice Address - Fax:781-581-1433
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice