Healthcare Provider Details

I. General information

NPI: 1699537183
Provider Name (Legal Business Name): OLEKSANDRA OLISHKEVYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 N PIMA RD STE 275
SCOTTSDALE AZ
85258-4488
US

IV. Provider business mailing address

112 WASHINGTON PARK APT 3
NEWTONVILLE MA
02460-1940
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-8799
  • Fax: 623-299-8799
Mailing address:
  • Phone: 872-772-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10000488
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10000488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: