Healthcare Provider Details

I. General information

NPI: 1174361299
Provider Name (Legal Business Name): MARGARET TIUKAENKO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARITA TIUKAENKO DDS

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14635 PENNOCK AVE STE 100
APPLE VALLEY MN
55124-6431
US

IV. Provider business mailing address

14635 PENNOCK AVE STE 100
APPLE VALLEY MN
55124-6431
US

V. Phone/Fax

Practice location:
  • Phone: 952-432-5509
  • Fax:
Mailing address:
  • Phone: 952-855-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2024028328
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: