=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699329235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLEKSIY MOTCH DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2019
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 2ND AVE S
-----------------------------------------------------
City | OKANOGAN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98840-0521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-476-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1340
-----------------------------------------------------
City | OKANOGAN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98840-1340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-422-8632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DE60983550
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0008X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
-----------------------------------------------------
License Number | DE60983550
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE60983550
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60983550
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------