Provider Demographics
NPI:1447016621
Name:VORONINA, NADEJDA
Entity type:Individual
Prefix:
First Name:NADEJDA
Middle Name:
Last Name:VORONINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 COFFEE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1343
Mailing Address - Country:US
Mailing Address - Phone:425-829-2986
Mailing Address - Fax:
Practice Address - Street 1:3501 COFFEE RD STE 9
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1343
Practice Address - Country:US
Practice Address - Phone:209-337-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1098911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice