Provider Demographics
NPI:1275148199
Name:CHUVASHOV, ARTEM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTEM
Middle Name:
Last Name:CHUVASHOV
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 1:240 NW GILMAN BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2418
Mailing Address - Country:US
Mailing Address - Phone:425-463-7067
Mailing Address - Fax:
Practice Address - Street 1:240 NW GILMAN BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2418
Practice Address - Country:US
Practice Address - Phone:425-463-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61085709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist