Provider Demographics
NPI:1669901153
Name:KRAVCHENKO, DMITRIY (DMD DO)
Entity type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:KRAVCHENKO
Suffix:
Gender:M
Credentials:DMD DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 N MILITARY TRL STE U
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4764
Mailing Address - Country:US
Mailing Address - Phone:561-468-5913
Mailing Address - Fax:
Practice Address - Street 1:1937 N MILITARY TRL STE U
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4764
Practice Address - Country:US
Practice Address - Phone:561-468-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN23208204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program