Provider Demographics
NPI:1275656191
Name:VASYLYK, NATALIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:VASYLYK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CHANNING WAY # 201
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2260
Mailing Address - Country:US
Mailing Address - Phone:510-866-6118
Mailing Address - Fax:
Practice Address - Street 1:2425 CHANNING WAY # 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2260
Practice Address - Country:US
Practice Address - Phone:510-866-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics