Provider Demographics
NPI:1417619941
Name:YURIJ CHERSTYLO DDS PLLC
Entity Type:Organization
Organization Name:YURIJ CHERSTYLO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YURIJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERSTYLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-872-8729
Mailing Address - Street 1:2362 MARLOW DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2112
Mailing Address - Country:US
Mailing Address - Phone:586-872-8729
Mailing Address - Fax:
Practice Address - Street 1:8027 S STATE RD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-7708
Practice Address - Country:US
Practice Address - Phone:810-636-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty