Provider Demographics
NPI:1053489112
Name:SHEVCHUK, ROBERT WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:SHEVCHUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 COLUMBIA RD
Mailing Address - Street 2:#5
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1477
Mailing Address - Country:US
Mailing Address - Phone:440-899-1070
Mailing Address - Fax:
Practice Address - Street 1:671 COLUMBIA RD
Practice Address - Street 2:#5
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1477
Practice Address - Country:US
Practice Address - Phone:440-899-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice