Provider Demographics
NPI:1659486488
Name:PASISNITCHENKO, IGOR (DDS)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:PASISNITCHENKO
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 1:10450 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2819
Mailing Address - Country:US
Mailing Address - Phone:954-431-0450
Mailing Address - Fax:954-435-0700
Practice Address - Street 1:10450 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2819
Practice Address - Country:US
Practice Address - Phone:954-431-0450
Practice Address - Fax:954-435-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice