Provider Demographics
NPI:1205348299
Name:CHUVASHOVA, YELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:CHUVASHOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 216TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9526
Mailing Address - Country:US
Mailing Address - Phone:425-269-9112
Mailing Address - Fax:
Practice Address - Street 1:240 NW GILMAN BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2418
Practice Address - Country:US
Practice Address - Phone:425-269-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60771035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist