Provider Demographics
NPI:1437366242
Name:TKACHYK, DARRYL B (DDS)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:B
Last Name:TKACHYK
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 1:25257 HURON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3600
Mailing Address - Country:US
Mailing Address - Phone:909-709-9757
Mailing Address - Fax:
Practice Address - Street 1:4434 UNIVERSITY PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-4681
Practice Address - Country:US
Practice Address - Phone:909-887-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice