Healthcare Provider Details

I. General information

NPI: 1467677674
Provider Name (Legal Business Name): YANA KUZNETSOVA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 BABCOCK RD STE 11
SAN ANTONIO TX
78249-2345
US

IV. Provider business mailing address

206 WILMINGTON AVE
SAN ANTONIO TX
78215-1401
US

V. Phone/Fax

Practice location:
  • Phone: 210-904-2888
  • Fax: 210-549-0040
Mailing address:
  • Phone: 210-551-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: