Provider Demographics
NPI:1336338227
Name:YEKATERINA MAMCHUR DDS PA
Entity Type:Organization
Organization Name:YEKATERINA MAMCHUR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMCHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-762-3460
Mailing Address - Street 1:51 MONROE PLACE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-762-3460
Mailing Address - Fax:301-762-3461
Practice Address - Street 1:51 MONROE PLACE
Practice Address - Street 2:SUITE 607
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-762-3460
Practice Address - Fax:301-762-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty