Healthcare Provider Details

I. General information

NPI: 1053072587
Provider Name (Legal Business Name): YASHCHUK DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 YGNACIO VALLEY RD STE 101
WALNUT CREEK CA
94598-3342
US

IV. Provider business mailing address

2161 YGNACIO VALLEY RD STE 101
WALNUT CREEK CA
94598-3342
US

V. Phone/Fax

Practice location:
  • Phone: 925-705-7093
  • Fax: 925-952-7050
Mailing address:
  • Phone: 925-705-7093
  • Fax: 925-952-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TATYANA LVOVNA YASHCHUK
Title or Position: CHIEF DENTIST/OWNER
Credential: DDS
Phone: 510-230-7270