Individual
EDWARD PUSHKAREV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2320 S 31ST ST STE 120, TEMPLE, TX 76504-2429
(484) 526-2460
Mailing address
13149 ALTA VISTA WAY, SYLMAR, CA 91342-3462
(310) 689-8657
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
38788
TX
Other
Enumeration date
05/11/2021
Last updated
07/23/2022
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