Healthcare Provider Details

I. General information

NPI: 1417619941
Provider Name (Legal Business Name): YURIJ CHERSTYLO DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 S STATE RD
GOODRICH MI
48438-7708
US

IV. Provider business mailing address

2362 MARLOW DR
WARREN MI
48092-2112
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-2808
  • Fax:
Mailing address:
  • Phone: 586-872-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. YURIJ CHERSTYLO
Title or Position: DENTIST
Credential: DDS
Phone: 586-872-8729