Provider Demographics
NPI:1043220007
Name:ZAVARNOVA BLEICHWEHL, NATALYA S (RDH)
Entity Type:Individual
Prefix:MS
First Name:NATALYA
Middle Name:S
Last Name:ZAVARNOVA BLEICHWEHL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:NATALYA
Other - Middle Name:S
Other - Last Name:BLEICHWEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2645 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2246
Mailing Address - Country:US
Mailing Address - Phone:414-445-9121
Mailing Address - Fax:
Practice Address - Street 1:1135 S CESAR E CHAVEZ DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2266
Practice Address - Country:US
Practice Address - Phone:414-645-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6467-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist