Provider Demographics
NPI:1962799841
Name:SHVARTSUR, OLEG A (DDS)
Entity type:Individual
Prefix:DR
First Name:OLEG
Middle Name:A
Last Name:SHVARTSUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 221ST PL SE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8927
Mailing Address - Country:US
Mailing Address - Phone:425-503-8020
Mailing Address - Fax:
Practice Address - Street 1:5825 221ST PL SE
Practice Address - Street 2:SUITE #101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-503-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60222150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist