Provider Demographics
NPI:1932638889
Name:TVERSKOY, IGOR (DMD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:TVERSKOY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:IGOR
Other - Middle Name:
Other - Last Name:TVERSKOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4000 SW ADMIRAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2516
Mailing Address - Country:US
Mailing Address - Phone:206-937-3350
Mailing Address - Fax:
Practice Address - Street 1:4000 SW ADMIRAL WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2516
Practice Address - Country:US
Practice Address - Phone:206-935-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607578821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice