Provider Demographics
NPI:1649629502
Name:ZMIEVSCHI, RUSLAN (DDS)
Entity type:Individual
Prefix:
First Name:RUSLAN
Middle Name:
Last Name:ZMIEVSCHI
Suffix:
Gender:M
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:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:LOTUS
Mailing Address - State:CA
Mailing Address - Zip Code:95651-0944
Mailing Address - Country:US
Mailing Address - Phone:530-621-0900
Mailing Address - Fax:
Practice Address - Street 1:7170 CA-49
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651-9565
Practice Address - Country:US
Practice Address - Phone:530-621-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist