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General NPI Number Information
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NPI Number | 1023962313
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Entity Type | Individual
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Provider Name | TATYANA VAKHLAKOVA RDH
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Gender | Female
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 6975 W GLENDALE AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-2611
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Country | US
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Telephone | 602-243-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 11048 N BALBOA DR
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City | SUN CITY
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State | AZ
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Zip | 85351-4207
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Country | US
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Telephone | 602-243-7277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H05488
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License Number State | AZ
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