Provider Demographics
NPI:1154541084
Name:MYASKOVSKY, DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MYASKOVSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 201ST PL SE APT 200
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8572
Mailing Address - Country:US
Mailing Address - Phone:425-488-2345
Mailing Address - Fax:425-489-4082
Practice Address - Street 1:1908 201ST PL SE APT 200
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8572
Practice Address - Country:US
Practice Address - Phone:425-488-2345
Practice Address - Fax:425-489-4082
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000070781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics