Individual
IRYNA HRYVENKO DALINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1920 E RIVERSIDE DR STE A-140, AUSTIN, TX 78741-1351
(512) 640-8747
Mailing address
11009 ALTERRA PKWY APT 1719, AUSTIN, TX 78758-1309
(612) 458-4781
(612) 626-0138
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401418170
VA
122300000X
Dentist
39193
TX
122300000X
Dentist
R665
MN
1223E0200X
Endodontics
Primary
39193
TX
1223X2210X
Orofacial Pain Dentistry
39193
TX
1223X2210X
Orofacial Pain Dentistry
S152
MN
Other
Enumeration date
07/27/2016
Last updated
09/15/2023
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