Provider Demographics
NPI:1245229939
Name:VERNOVSKY, EDUARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARD
Middle Name:
Last Name:VERNOVSKY
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 1:8200 WEDNESBURY LN
Mailing Address - Street 2:310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2925
Mailing Address - Country:US
Mailing Address - Phone:281-501-0898
Mailing Address - Fax:281-501-0898
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:310
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:281-501-0898
Practice Address - Fax:281-501-0898
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190233091223G0001X
TX273491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004089Medicaid