Provider Demographics
NPI:1851788327
Name:L.KRAVCHUK DENTAL CORPORATION
Entity type:Organization
Organization Name:L.KRAVCHUK DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S
Authorized Official - Prefix:DR
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-727-1107
Mailing Address - Street 1:6240 SAN JUAN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-5642
Mailing Address - Country:US
Mailing Address - Phone:916-727-1107
Mailing Address - Fax:
Practice Address - Street 1:6240 SAN JUAN AVE
Practice Address - Street 2:SUITE#F
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:916-727-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty