Individual
MISS YANA KAPUSTINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2641 N 44TH ST STE 101, PHOENIX, AZ 85008-1573
(602) 698-0234
Mailing address
2641 N 44TH ST STE 101, PHOENIX, AZ 85008-1573
(917) 696-1497
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9955
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
01/29/2019
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