Individual
VIACHESLAV LITVINENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1700 MONROE ST, ENDICOTT, NY 13760
(718) 249-9503
Mailing address
1700 MONROE ST, ENDICOTT, NY 13760-5512
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
059814
NY
1223P0221X
Pediatric Dentistry
22DI02714600
NJ
Other
Enumeration date
03/07/2016
Last updated
07/25/2018
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