Healthcare Provider Details

I. General information

NPI: 1043414493
Provider Name (Legal Business Name): VLADIMIR GAVRILYUK DENTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S DIVISION ST SUITE B
AUBURN WA
98001-5332
US

IV. Provider business mailing address

1901 37TH WAY SE
AUBURN WA
98002-8234
US

V. Phone/Fax

Practice location:
  • Phone: 253-931-0225
  • Fax:
Mailing address:
  • Phone: 253-735-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000308
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: