MEDICARE: DR. NADIA CHERNYAVSKAYA DMD

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	10892	AZ

General Provider Information

NPI Number	:	1336397611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADIA CHERNYAVSKAYA DMD

Provider Business Mailing Address
First Line	:	1109 S 241ST AVE
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-1871
Country	:	US
Telephone Number	:	773-679-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 W BASELINE RD # DTE176
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6574
Country	:	US
Telephone Number	:	602-842-6289
Fax Number	:

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	02/15/2021

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