Healthcare Provider Details

I. General information

NPI: 1932638889
Provider Name (Legal Business Name): IGOR TVERSKOY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: IGOR TVERSKOY DMD

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SW ADMIRAL WAY
SEATTLE WA
98116-2516
US

IV. Provider business mailing address

4000 SW ADMIRAL WAY
SEATTLE WA
98116-2516
US

V. Phone/Fax

Practice location:
  • Phone: 206-935-2632
  • Fax:
Mailing address:
  • Phone: 206-937-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60757882
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: