Healthcare Provider Details

I. General information

NPI: 1841797545
Provider Name (Legal Business Name): OLEG PROKOPENKO DN 28013
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 604E
MIAMI FL
33176-2175
US

IV. Provider business mailing address

8940 N KENDALL DR STE 604E
MIAMI FL
33176-2175
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1905
  • Fax: 305-595-2219
Mailing address:
  • Phone: 305-595-1905
  • Fax: 305-595-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN28013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: