Provider Demographics
NPI:1053072587
Name:YASHCHUK DENTAL, P.C.
Entity type:Organization
Organization Name:YASHCHUK DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:LVOVNA
Authorized Official - Last Name:YASHCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-230-7270
Mailing Address - Street 1:2161 YGNACIO VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3342
Mailing Address - Country:US
Mailing Address - Phone:925-705-7093
Mailing Address - Fax:925-952-7050
Practice Address - Street 1:2161 YGNACIO VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3342
Practice Address - Country:US
Practice Address - Phone:925-705-7093
Practice Address - Fax:925-952-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty