Provider Demographics
NPI:1700032315
Name:KOVALCHUK, DENYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENYS
Middle Name:
Last Name:KOVALCHUK
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 1:300 BUCHANAN ST
Mailing Address - Street 2:APT 401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6102
Mailing Address - Country:US
Mailing Address - Phone:215-820-8700
Mailing Address - Fax:
Practice Address - Street 1:300 BUCHANAN ST
Practice Address - Street 2:APT 401
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6102
Practice Address - Country:US
Practice Address - Phone:215-820-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice