Provider Demographics
NPI:1831702828
Name:BORISYUK, OLEG (LDH)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:BORISYUK
Suffix:
Gender:M
Credentials:LDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2133
Mailing Address - Country:US
Mailing Address - Phone:615-522-7124
Mailing Address - Fax:
Practice Address - Street 1:804 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4106
Practice Address - Country:US
Practice Address - Phone:812-324-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13007834A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist