Provider Demographics
NPI:1649407263
Name:PLOTNIK, IGOR (DMD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:PLOTNIK
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 1:10108 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3704
Mailing Address - Country:US
Mailing Address - Phone:215-677-3904
Mailing Address - Fax:215-677-2401
Practice Address - Street 1:10108 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3704
Practice Address - Country:US
Practice Address - Phone:215-677-3904
Practice Address - Fax:215-677-2401
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist