Provider Demographics
NPI:1376671156
Name:GRISHKO, YURI (DDS)
Entity Type:Individual
Prefix:DR
First Name:YURI
Middle Name:
Last Name:GRISHKO
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 1:500 E JEFFERY AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5030
Mailing Address - Country:US
Mailing Address - Phone:847-465-9577
Mailing Address - Fax:847-850-5045
Practice Address - Street 1:500 E JEFFERY AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5030
Practice Address - Country:US
Practice Address - Phone:847-465-9577
Practice Address - Fax:847-850-5045
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004506Medicaid