Individual
DR. VYACHESLAV DMYTRUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1729 W HARVARD AVE STE 2, ROSEBURG, OR 97471-2795
(458) 802-7028
(541) 516-4345
Mailing address
1729 W HARVARD AVE STE 2, ROSEBURG, OR 97471-2795
(458) 802-7028
(541) 516-4345
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11399
OR
1223G0001X
General Practice Dentistry
Primary
D11399
OR
1223G0001X
General Practice Dentistry
DEN4408
ME
Other
Enumeration date
12/01/2014
Last updated
02/01/2021
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