Provider Demographics
NPI:1407110471
Name:OLEG A SHVARTSUR DDS PLLC
Entity Type:Organization
Organization Name:OLEG A SHVARTSUR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHVARTSUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-503-8020
Mailing Address - Street 1:710 NW JUNIPER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2717
Mailing Address - Country:US
Mailing Address - Phone:425-392-4600
Mailing Address - Fax:425-392-0503
Practice Address - Street 1:710 NW JUNIPER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2717
Practice Address - Country:US
Practice Address - Phone:425-392-4600
Practice Address - Fax:425-392-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60222150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty