Provider Demographics
NPI:1528302460
Name:DMITRY Y TSVETOV DDS MD INC
Entity type:Organization
Organization Name:DMITRY Y TSVETOV DDS MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TSVETOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:877-667-7669
Mailing Address - Street 1:PO BOX 269006
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9006
Mailing Address - Country:US
Mailing Address - Phone:877-667-7669
Mailing Address - Fax:405-848-0033
Practice Address - Street 1:31560 RANCHO PUEBLO RD
Practice Address - Street 2:101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4858
Practice Address - Country:US
Practice Address - Phone:951-302-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty