Provider Demographics
NPI:1851838585
Name:VASILYEV, KIRILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRILL
Middle Name:
Last Name:VASILYEV
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 1:9733 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3201
Mailing Address - Country:US
Mailing Address - Phone:215-774-5050
Mailing Address - Fax:215-437-7874
Practice Address - Street 1:9733 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3201
Practice Address - Country:US
Practice Address - Phone:215-774-5050
Practice Address - Fax:215-437-7874
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415489122300000X
PADS041131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist