Provider Demographics
NPI:1720516685
Name:SOMCHENKO, OKSANA VALENTINOVNA (DMD)
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:VALENTINOVNA
Last Name:SOMCHENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:OKSANA
Other - Middle Name:VALENTINOVNA
Other - Last Name:FURSOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 E FARNHAM LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6402
Mailing Address - Country:US
Mailing Address - Phone:920-713-8978
Mailing Address - Fax:
Practice Address - Street 1:2442 COUNTY HWY 10
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:763-316-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty