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Organization
DENTAL VISION PC
Active
Organization
DENTAL VISION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IGOR SHISHKIN DDS (DOCTOR/PRESIDENT)
(541) 471-7062
Entity
Organization
Contact information
Practice address
934 NE 8TH ST, GRANTS PASS, OR 97526-1641
(541) 471-7062
(541) 471-8539
Mailing address
934 NE 8TH ST, GRANTS PASS, OR 97526-1641
(541) 471-7062
(541) 471-8539
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6927
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122676
—
OR
Enumeration date
06/02/2006
Last updated
08/22/2020
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