Provider Demographics
NPI:1245894740
Name:YARMOLICH, OKSANA (RDH/RDA)
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:YARMOLICH
Suffix:
Gender:F
Credentials:RDH/RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2236
Mailing Address - Country:US
Mailing Address - Phone:651-602-7500
Mailing Address - Fax:651-602-7518
Practice Address - Street 1:478 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2236
Practice Address - Country:US
Practice Address - Phone:651-602-7500
Practice Address - Fax:651-602-7518
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA9581126800000X
MNH7601124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant