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General NPI Number Information
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NPI Number | 1386174126
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Entity Type | Individual
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Provider Name | DR. RUSLAN SEMCHYSHYN
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Gender | Male
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 671 LUMPKIN CAMPGROUND RD S STE 110
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City | DAWSONVILLE
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State | GA
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Zip | 30534-0931
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Country | US
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Telephone | 706-265-0070
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Fax | 706-265-0072
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Provider Business Mailing Address
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Address Line | 3590 REGENCY PARK DR
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City | DULUTH
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State | GA
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Zip | 30096-3818
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Country | US
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Telephone | 770-789-0989
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015449
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License Number State | GA
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