Provider Demographics
NPI:1689891228
Name:YASHCHUK, TATYANA (DDS)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:YASHCHUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 YGNACIO VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3342
Mailing Address - Country:US
Mailing Address - Phone:925-705-7093
Mailing Address - Fax:925-952-7050
Practice Address - Street 1:2161 YGNACIO VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3342
Practice Address - Country:US
Practice Address - Phone:925-705-7093
Practice Address - Fax:925-952-7050
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49255OtherDENTAL LICENSE