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General NPI Number Information
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NPI Number | 1508719154
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Entity Type | Individual
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Provider Name | EKATERINA KOKOREVA
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Gender | Female
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 30 CANTON ST STE 12
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City | MANCHESTER
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State | NH
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Zip | 03103-3524
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Country | US
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Telephone | 603-668-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 107 S RIVER RD APT 419
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City | BEDFORD
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State | NH
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Zip | 03110-6785
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 04214
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License Number State | NH
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