Healthcare Provider Details

I. General information

NPI: 1619000247
Provider Name (Legal Business Name): VICTOR R PLAVSKY LD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24610 36TH AVE S
KENT WA
98032-1520
US

IV. Provider business mailing address

PO BOX 58
SNOQUALMIE WA
98065-0058
US

V. Phone/Fax

Practice location:
  • Phone: 253-941-5400
  • Fax: 866-297-7419
Mailing address:
  • Phone: 253-941-5400
  • Fax: 866-297-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: