Provider Demographics
NPI:1508887787
Name:PASTOUKH, VLADIMIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:PASTOUKH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 S GREENWAY CT
Mailing Address - Street 2:UNIT D
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1987
Mailing Address - Country:US
Mailing Address - Phone:440-543-9000
Mailing Address - Fax:440-543-1562
Practice Address - Street 1:3550 LANDER RD
Practice Address - Street 2:#140
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5727
Practice Address - Country:US
Practice Address - Phone:216-292-3600
Practice Address - Fax:216-292-3794
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH216391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice