Healthcare Provider Details

I. General information

NPI: 1003381302
Provider Name (Legal Business Name): TVERSKOY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
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

5950 31ST AVE SW
SEATTLE WA
98126-2910
US

V. Phone/Fax

Practice location:
  • Phone: 206-935-2632
  • Fax:
Mailing address:
  • Phone: 206-383-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IGOR TVERSKOY
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 206-383-4467