Healthcare Provider Details

I. General information

NPI: 1861412264
Provider Name (Legal Business Name): INNA N KIREENKOV RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S GEORGE ST
YORK PA
17401-1408
US

IV. Provider business mailing address

116 S GEORGE ST SUITE 301
YORK PA
17401-1408
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-8617
  • Fax: 717-718-1317
Mailing address:
  • Phone: 717-845-8617
  • Fax: 717-718-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH068296
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: