Provider Demographics
NPI:1316077407
Name:SHKLOVSKY, VICTORIA (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:SHKLOVSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17011 LINCOLN AVE # 561
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3144
Mailing Address - Country:US
Mailing Address - Phone:970-433-9777
Mailing Address - Fax:
Practice Address - Street 1:9450 E MISSISSIPPI AVE UNIT A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2427
Practice Address - Country:US
Practice Address - Phone:303-503-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048297-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6199200001OtherMEDICARE SUPPLIER
NYDF073D9491Medicare PIN