Healthcare Provider Details

I. General information

NPI: 1659296747
Provider Name (Legal Business Name): VIKA IVANOVNA LEONCHIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14406 NE 20TH AVE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

505 SE 184TH AVE UNIT 228
VANCOUVER WA
98683-1938
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 971-472-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDEHY.DH.70143312
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: