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General NPI Number Information
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NPI Number | 1225310592
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Entity Type | Individual
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Provider Name | IRYNA KORNIYENKO YELISETTY D.M.D, M.S.D.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 17512 RADIANT SHINE WAY
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City | LUTZ
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State | FL
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Zip | 33558-5735
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Country | US
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Telephone | 251-458-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 1475 PEACHTREE PKWY STE C3
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City | CUMMING
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State | GA
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Zip | 30041-9793
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Country | US
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Telephone | 470-253-1747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN28893
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License Number State | FL
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