1821654450 NPI number — VYACHESLAV P ZALYASHKO DENTURIST

Table of content: VYACHESLAV P ZALYASHKO DENTURIST (NPI 1821654450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821654450 NPI number — VYACHESLAV P ZALYASHKO DENTURIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZALYASHKO
Provider First Name:
VYACHESLAV
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTURIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821654450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15506 NE 82ND CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682-3745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-771-7776
Provider Business Mailing Address Fax Number:
360-256-2829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13720 NE 28TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98682-8289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-256-4656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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