MEDICARE: DR. LINDA KORNIENKO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25016	FL

General Provider Information

NPI Number	:	1477179109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA KORNIENKO DDS

Provider Business Mailing Address
First Line	:	1905 SE 26TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-3248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 HARBOR VILLAGE LN
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3426
Country	:	US
Telephone Number	:	813-737-7370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	06/18/2020

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