Provider Demographics
NPI:1902296809
Name:TATYANA YASHCHUK
Entity Type:Organization
Organization Name:TATYANA YASHCHUK
Other - Org Name:GOLDEN STATE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YASHCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-705-7093
Mailing Address - Street 1:2161 YGNACIO VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3342
Mailing Address - Country:US
Mailing Address - Phone:925-705-7093
Mailing Address - Fax:925-952-7050
Practice Address - Street 1:2161 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3396
Practice Address - Country:US
Practice Address - Phone:925-705-7093
Practice Address - Fax:925-952-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49255261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689891228OtherNPI