Healthcare Provider Details

I. General information

NPI: 1578356192
Provider Name (Legal Business Name): MARYANA ZAVERUKHA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-9576
US

IV. Provider business mailing address

4014 WINTER GARDEN VINELAND RD STE B
WINTER GARDEN FL
34787-9576
US

V. Phone/Fax

Practice location:
  • Phone: 321-248-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: