Individual
DR. KSENIA ANDRONOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
275 N PHELPS AVE, ROCKFORD, IL 61108-2434
(815) 484-8678
(815) 484-8680
Mailing address
5047 LINDEN RD APT 6311, ROCKFORD, IL 61109-5866
(815) 874-1509
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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