Provider Demographics
NPI:1003381302
Name:TVERSKOY PLLC
Entity Type:Organization
Organization Name:TVERSKOY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TVERSKOY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-383-4467
Mailing Address - Street 1:5950 31ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2910
Mailing Address - Country:US
Mailing Address - Phone:206-383-4467
Mailing Address - Fax:
Practice Address - Street 1:4000 SW ADMIRAL WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2516
Practice Address - Country:US
Practice Address - Phone:206-935-2632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental