Provider Demographics
NPI:1386174126
Name:SEMCHYSHYN, RUSLAN
Entity type:Individual
Prefix:DR
First Name:RUSLAN
Middle Name:
Last Name:SEMCHYSHYN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3818
Mailing Address - Country:US
Mailing Address - Phone:770-789-0989
Mailing Address - Fax:
Practice Address - Street 1:671 LUMPKIN CAMPGROUND RD S STE 110
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0931
Practice Address - Country:US
Practice Address - Phone:706-265-0070
Practice Address - Fax:706-265-0072
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice