Provider Demographics
NPI:1336694983
Name:REVUTSKA, IRYNA P (RDH)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:P
Last Name:REVUTSKA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SE 136TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6908
Mailing Address - Country:US
Mailing Address - Phone:360-896-9595
Mailing Address - Fax:
Practice Address - Street 1:217 SE 136TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6908
Practice Address - Country:US
Practice Address - Phone:360-896-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60671848124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist