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General NPI Number Information
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NPI Number | 1043414493
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Entity Type | Individual
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Provider Name | VLADIMIR GAVRILYUK DENTURIST
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 201 S DIVISION ST SUITE B
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City | AUBURN
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State | WA
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Zip | 98001-5332
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Country | US
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Telephone | 253-931-0225
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 37TH WAY SE
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City | AUBURN
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State | WA
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Zip | 98002-8234
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Country | US
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Telephone | 253-735-6506
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN00000308
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License Number State | WA
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