Provider Demographics
NPI:1457613036
Name:UKOLOVA, INGA (DDS)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:UKOLOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 TAMPA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-5619
Mailing Address - Country:US
Mailing Address - Phone:727-789-4044
Mailing Address - Fax:727-781-0543
Practice Address - Street 1:3830 TAMPA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-5619
Practice Address - Country:US
Practice Address - Phone:727-789-4044
Practice Address - Fax:727-781-0543
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL198651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice