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General NPI Number Information
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NPI Number | 1942071857
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Entity Type | Individual
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Provider Name | ELENA STOROZHENKO DDS
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Gender | Female
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 205 VILLAGE COMMONS DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-4544
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Country | US
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Telephone | 904-780-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 410 WEXFORD WAY APT 5-547
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-0124
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28744
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License Number State | FL
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