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General NPI Number Information
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NPI Number | 1437366242
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Entity Type | Individual
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Provider Name | DARRYL B TKACHYK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4434 UNIVERSITY PKWY SUITE G
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4681
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Country | US
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Telephone | 909-887-1533
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Fax |
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Provider Business Mailing Address
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Address Line | 25257 HURON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-3600
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Country | US
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Telephone | 909-709-9757
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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 | 49814
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License Number State | CA
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