Provider Demographics
NPI:1811519192
Name:ISHCHUK, VIKTORIYA A (DDS)
Entity type:Individual
Prefix:DR
First Name:VIKTORIYA
Middle Name:A
Last Name:ISHCHUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3554
Mailing Address - Country:US
Mailing Address - Phone:952-888-4125
Mailing Address - Fax:
Practice Address - Street 1:10611 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3554
Practice Address - Country:US
Practice Address - Phone:952-888-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND145311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice