MEDICARE: DAVID MYASKOVSKY D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DE00007078	WA

General Provider Information

NPI Number	:	1154541084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MYASKOVSKY D.D.S

Provider Business Mailing Address
First Line	:	1908 201ST PL SE APT 200
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-8572
Country	:	US
Telephone Number	:	425-488-2345
Fax Number	:	425-489-4082

Provider Business Practice Location Address
First Line	:	1908 201ST PL SE APT 200
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-8572
Country	:	US
Telephone Number	:	425-488-2345
Fax Number	:	425-489-4082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	06/29/2021

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