Provider Demographics
NPI:1275513848
Name:WYNNYKIW, ASKOLD ROMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASKOLD
Middle Name:ROMAN
Last Name:WYNNYKIW
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 1:351 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1660
Mailing Address - Country:US
Mailing Address - Phone:518-432-3991
Mailing Address - Fax:518-432-3987
Practice Address - Street 1:351 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1660
Practice Address - Country:US
Practice Address - Phone:518-432-3991
Practice Address - Fax:518-432-3987
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0412581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141817590OtherFEDERAL TAX ID