Provider Demographics
NPI:1366890428
Name:VYSHNEVSKY, OLGA (DMD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:VYSHNEVSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2411
Mailing Address - Country:US
Mailing Address - Phone:202-509-2259
Mailing Address - Fax:
Practice Address - Street 1:165 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2509
Practice Address - Country:US
Practice Address - Phone:202-509-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026761001223G0001X
NY0593781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty