Provider Demographics
NPI:1336397611
Name:CHERNYAVSKAYA, NADIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:
Last Name:CHERNYAVSKAYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NADEZHDA
Other - Middle Name:
Other - Last Name:CHERNYAVSKAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1109 S 241ST AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1871
Mailing Address - Country:US
Mailing Address - Phone:773-679-2288
Mailing Address - Fax:
Practice Address - Street 1:2030 W BASELINE RD # DTE176
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6574
Practice Address - Country:US
Practice Address - Phone:602-842-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ108921223G0001X, 1223G0001X
IL019027771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist