Provider Demographics
NPI:1174674402
Name:ZBARASCHUK, EDWARD RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RICHARD
Last Name:ZBARASCHUK
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 1:645 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3001
Mailing Address - Country:US
Mailing Address - Phone:360-683-3626
Mailing Address - Fax:360-683-2384
Practice Address - Street 1:645 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3001
Practice Address - Country:US
Practice Address - Phone:360-683-3626
Practice Address - Fax:360-683-2384
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000064461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice