Provider Demographics
NPI:1801919113
Name:PIYEVSKY PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:PIYEVSKY PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIYEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-304-1234
Mailing Address - Street 1:7481 W LAKE MEAD BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0285
Mailing Address - Country:US
Mailing Address - Phone:702-304-1234
Mailing Address - Fax:702-304-9499
Practice Address - Street 1:7481 W LAKE MEAD BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0285
Practice Address - Country:US
Practice Address - Phone:702-304-1234
Practice Address - Fax:702-304-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty