Provider Demographics
NPI:1740612928
Name:KRYSCHUK, SVIATOSLAV (DDS)
Entity Type:Individual
Prefix:
First Name:SVIATOSLAV
Middle Name:
Last Name:KRYSCHUK
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 1:8 POWDER MILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-2407
Mailing Address - Country:US
Mailing Address - Phone:401-232-0862
Mailing Address - Fax:
Practice Address - Street 1:12 BREAKNECK HILL RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3909
Practice Address - Country:US
Practice Address - Phone:401-726-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN031921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice