Provider Demographics
NPI:1932313970
Name:KRAVCHUK, LYUDMILA (D D S)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:KRAVCHUK
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 SAN JUAN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5642
Mailing Address - Country:US
Mailing Address - Phone:916-727-1107
Mailing Address - Fax:916-727-1099
Practice Address - Street 1:6240 SAN JUAN AVE STE F
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5642
Practice Address - Country:US
Practice Address - Phone:916-727-1107
Practice Address - Fax:916-727-1099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice