Healthcare Provider Details

I. General information

NPI: 1255590923
Provider Name (Legal Business Name): ARINA SERGEEVNA DOROSHENKO DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARINA SERGEEVNA KONDRAKHINA

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 LITHIA PINECREST RD
VALRICO FL
33596-5627
US

IV. Provider business mailing address

2922 LITHIA PINECREST RD
VALRICO FL
33596-5627
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-2563
  • Fax:
Mailing address:
  • Phone: 813-336-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14338
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN23056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: