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General NPI Number Information
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NPI Number | 1831702828
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Entity Type | Individual
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Provider Name | OLEG BORISYUK LDH
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Gender | Male
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 804 S GREEN RIVER RD
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City | EVANSVILLE
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State | IN
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Zip | 47715-4106
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Country | US
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Telephone | 812-324-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 5311 OAKWOOD DR
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City | NEWBURGH
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State | IN
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Zip | 47630-2133
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Country | US
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Telephone | 615-522-7124
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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 | 13007834A
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License Number State | IN
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