MEDICARE: DR. VICTORIA SHKLOVSKY 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	1223G0001X	General Practice Dentistry	048297-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6199200001	OTHER	NY	MEDICARE SUPPLIER

General Provider Information

NPI Number	:	1316077407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA SHKLOVSKY D.D.S.

Provider Business Mailing Address
First Line	:	17011 LINCOLN AVE # 561
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-3144
Country	:	US
Telephone Number	:	970-433-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	9450 E MISSISSIPPI AVE UNIT A
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2427
Country	:	US
Telephone Number	:	303-503-3260
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/02/2021

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