Healthcare Provider Details

I. General information

NPI: 1033428552
Provider Name (Legal Business Name): VIKTOR MAZURETS DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 39TH AVE NE
SEATTLE WA
98105-3040
US

IV. Provider business mailing address

431 E WARD ST
KENT WA
98030-4537
US

V. Phone/Fax

Practice location:
  • Phone: 253-905-5633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: VIKTOR MAZURETS
Title or Position: DDS
Credential:
Phone: 253-905-5633