Provider Demographics
NPI:1720316250
Name:POKROVSKAYA, NADEZHDA DMITRIEVNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADEZHDA
Middle Name:DMITRIEVNA
Last Name:POKROVSKAYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:D
Other - Last Name:POKROVSKAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2722 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1770
Mailing Address - Country:US
Mailing Address - Phone:229-247-1661
Mailing Address - Fax:229-247-8051
Practice Address - Street 1:2722 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1770
Practice Address - Country:US
Practice Address - Phone:229-247-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551241223G0001X
GADN0142951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice