Healthcare Provider Details

I. General information

NPI: 1306768304
Provider Name (Legal Business Name): VASYL TKACHYK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SE 164TH AVE STE 200
VANCOUVER WA
98683-9603
US

IV. Provider business mailing address

16516 SE MILL PLAIN BLVD APT 331
VANCOUVER WA
98684-9605
US

V. Phone/Fax

Practice location:
  • Phone: 360-260-1005
  • Fax:
Mailing address:
  • Phone: 323-820-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70142714
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: